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Cryo-surgery 90% success rate

Posted by Pauline on 10/13/04 at 16:42 (161441)

Found this article on 'Cryo-surgery'. I believe it's the same treatment that Dr. Z went to take a look at, but I don't know if it was at Oakwood Hospital. After what you learned Dr. Z, can patients really count on a 90% success rate from this procedure. This just hit the newspaper in Mich.

Cryo-Surgery: A lasting solution for a painful problem
Date: 10/12/2004
Contact: Tom Worobec

Lawrence Fallat, DPM, director of the Podiatric Surgical Residency program at Oakwood Healthcare System (OHS) is pioneering a new, minimally invasive surgical procedure to treat the problem of heel pain.

'It's an innovative technique,' said Dr. Fallat. 'Cryo-surgery has been used for decades to treat prostate cancer and melanoma. Now, we're taking it and applying it to the foot, specifically for those people who are suffering from plantar fasciitis, which is the inflammation of a tough band of tissue on the bottom of the foot. This inflammation causes extreme heel pain. And we are seeing dramatic results.'

The procedure to treat the heel pain lasts about six to seven minutes and happens right in Dr. Fallat's office. A three-millimeter incision is placed in the heel of the foot where a two-millimeter tube is then inserted. The tube is extremely cold. It freezes and destroys the pain nerves in the heel.

'Those nerves will grow back but the pain does not come back with them,' explained Dr. Fallat. 'There is no permanent damage to the foot, no permanent numbness or balance and mobility problems.'

The healing period lasts about two to three days.

'It's nothing like the six-week healing period for other types of surgeries that treat plantar fasciitis,' said Dr. Fallat.

One of the other assets of this program is its success rate.

'This treatment is very effective,' said Dr. Fallat. 'The procedure has a 90 percent success rate, and these are people who have failed all of the other conventional treatments available.'

Currently, Dr. Fallat is the only physician in Michigan to perform this procedure as a treatment for plantar fasciitis. To schedule an appointment, call 800.543.WELL.

Re: Cryo-surgery 90% success rate

Dr. Z on 10/13/04 at 17:48 (161447)

Pauline,

Here is what I have learned during my study with Dr. Trescott. Dr. Trescott is an expert in the field of cryotherapy for pain managment. She only favors cryotherapy for plantar fasciitis when it is nerve related NOT when there is any painful site.. Dr. Fallat has a difference of opinion with Dr. Trescott's approach. I have no opinion either way except from a logical and scientific approach I go along with Dr. Trescott. I must say that I am coming from an ESWT approach and backgroud to plantar fasciosis.
I posted the results for neuroma treatment and the results weren't 90%

Re: Cryo-surgery 90% success rate

chrisb on 10/13/04 at 21:45 (161458)

I'm very interested to learn more about this. 3 questions, if you please:

1: I've read that when a nerve is cut, to avoid growth of painful stump neuromas surgeons often implant the end of the nerve in a muscle. How does cryotherapy avoid this problem, or does it?
2: Dr Z says cryotherapy is favoured '...not when there is any painful site...' Do you mean that this is not indicated if there is any heel pain at all, i.e only when there's nerve tingles?
3: How does the cryoptherapy administrator accurately locate the nerve in order to inject it?
Thanks.
Chris

Re: Cryo-surgery 90% success rate

chrisb on 10/13/04 at 21:47 (161460)

I'm very interested to learn more about this. 3 questions, if you please:

1: I've read that when a nerve is cut, to avoid growth of painful stump neuromas surgeons often implant the end of the nerve in a muscle. How does cryotherapy avoid this problem, or does it?
2: Dr Z says cryotherapy is favoured '...not when there is any painful site...' Do you mean that this is not indicated if there is any heel pain at all, i.e only when there's nerve tingles?
3: How does the cryoptherapy administrator accurately locate the nerve in order to inject it?
Thanks.
Chris

Re: Cryo-surgery 90% success rate

Dr. Z on 10/13/04 at 21:54 (161461)

Hi

1. There is no cutting with cryotherapy. There is a freezing of the outer covering of the nerve which blocks pain transmission. There is then a regeneration which takes about nine months. One of three things will happen. New nerve memory that is pain free, new pathway that is pain free or return of the original pain.
2.It is favored only when there is a specific nerve involvement. With heel pain that would be the medial and or lateral nerve
3. Good question. You are treating a painful site with plantar fasciitis that isn't related to a specific nerve. This is done by placing the probe into a specific painful area. This is done by feel by the physician. and experience. I hope that I have made my explanation clear. Feel free to ask additional questions if needed

Re: Cryo-surgery 90% success rate

chrisb on 10/14/04 at 09:38 (161486)

The board seems to be double-posting.
Thanks for the info. So there's no surety of whether there'll be pain after regeneration. Does the cryo probe (I'm imagining a kind of needle) actually go into the nerve itself or does it freeze an area of tissue in the vicinity?

When you say its favoured only when specific nerve involvement. TTS surgery is in the tunnel area of course. I guess cryotherapy focuses on the actual pain site, for example around the insertion site, or mid-heel? Is it ever used when TTS surgery has not alleviated the pain?

When a diagnostic shot of marcaine into the area numbs the pain, would that indicate that cryotherapy might work -- and would it pinpoint the area for the cryo probe? (i.e. the same place the marcaine was injected)?

Re: Crysurgery Still So New

Darlene on 10/14/04 at 10:14 (161487)

Hi Chris.

I spoke with one of the providers a couple of months ago and it is still so very new. I asked to speak to someone who had the surgery and I spoke with an employee at the podiatrist's office. I learned the hard way from my first surgery that I should talk to people with no vested interest. Someone on this board was going to give it a try for PF, but I haven't seen any postings since.

It sounds like you still don't have a solid diagnosis. I'm investigating neurography as a possible diagnostic tool. http://www.neurography.com

Also, if cryosurgery could work, I would think that alcohol injections could do the same thing. Perhaps one of the doctors could comment.

How was your tts diagnosed? Did you have a diagnostic ultrasound or an MRI?

Also, as a fellow Canadian would you mind e-mailing me at (email removed) I have a couple of questions. You are from my favourite part of Canada.

Darlene

Re: Crysurgery Still So New

chrisb on 10/14/04 at 11:17 (161492)

Darlene I've been wondering the same thing - wouldn't it be like alcohol injections?
Maybe this is used primarily for mortons neuromas, not heel pain per se?

Re: Crysurgery Still So New

Curt on 10/14/04 at 12:22 (161501)

Hi,

I had the cryosurgery done at Dr. Fallot's office on 9-28. I have PF in both feet, just the right foot was treated. Unfortunately for me it did nothing. My foot feels the same with no pain reduction at all.

The procedure itself is almost painless. They inject your foot to numb it and that is really the only minor pain involved. A small incision is made near the area to be treated and the probe is inserted. Then an iceball is formed over the painful area about the size of a half dollar. The area treated is determined beforehand by you and the doctor finding the most tender spot on your foot. In my case it was just in front of the heel.

Healing was rapid. I had some bruising and tenderness but it is gone now. I haven't gone back to see him yet as I had to cancel my return appointment this week. I was really hoping for at least some pain reduction so it's kind of depressing. Back to square one.

Re: Crysurgery Still So New

Dr. Z on 10/14/04 at 16:52 (161519)

Hi
It is similiar but a different level of nerve lysis.

Re: Curt

Darlene on 10/14/04 at 16:54 (161521)

Curt:

Thank you for posting your results.

Before the surgery, I am curious as to what you were told the likelihood of success was.

Thanks.

Darlene

Re: Cryo-surgery 90% success rate

Dr. Z on 10/14/04 at 16:56 (161522)

Clarificaton: Cryotherapy is indicated when the CAUSE of the painful area is one of the sensory nerves such as the medial and or lateral plantar nerve. It isn't indicated for trigger point area of pain that are due to plantar fasciosis which is a degeneration of tissue and not nerve related. Sorry for the confusion

Re: Crysurgery Still So New

Darlene on 10/14/04 at 17:21 (161525)

Dr. Z.

Would you be able to elaborate on this? It would be very much appreciated.

Darlene

Re: Cryo-surgery 90% success rate

Ed Davis, DPM on 10/14/04 at 20:58 (161543)

Pauline:

How does Dr. Fallat propose that the cryosuyrgery procedure can SELECTIVELY target the nerves without harming other tissue surrounding the area?

My index of suspicion tends to go up when a practitioner goes straight to the public (ie. marketing) a 'new' procedure BEFORE reasonable presentation and study has been performed by colleagues. Be careful when one practitioner exclaims 'eureka' I am the only one with the cure that others don't know about. Maybe he is onto something but maybe he is not.
Ed

Re: Cryo-surgery 90% success rate

Dr. Z on 10/14/04 at 21:42 (161551)

Ed,

I believe he has be using the procedure for a few year now.

Re: Cryo-surgery 90% success rate

Cyndi on 10/15/04 at 09:01 (161568)

I also had Cryo-surgery on my left foot in May 2004. The injection site just needs a band-aid for a few days..My foot also bruised and I used a cane to try to keep off it till bruising was gone. My problem was not a specific site for pain but whole arch pain in both feet.
This surgery did nothing for me, but, I am not saying it would not for anyone.
Since then my foot nerves(both feet) have been very active and I am now seeing a Neurologist and taking Neurontin for the pain. I still am having trouble wearing enclosed shoes and socks today, It feels like I can feel every thread in the socks.I have just been wearing sandels and that is ok. The lightning in my feet had disappeared with the RX and just wearing sandels.
That nerve also involves your back, which is also bothering me now.

I have photos I took of my foot daily if anyone would like to see, just E-mail me @ (email removed). I sure wish it had worked for me as the recovery was very easy, Just find a good book to read while resting that foot.

Re: Curt

Curt on 10/15/04 at 09:03 (161569)

Darlene,

I believe it was 90% or better.

Re: Cryo-surgery 90% success rate

john h on 10/15/04 at 19:04 (161617)

Ed: If somewone truly comes up with a procedure that will cure PF 90% of the time he will be the next Bill Gates. How many procedures have we seem on this site where someone claims a 90% success rate? I become highly suspicious when I see such claims. We have 3-6 million new case of PF yearly so any such success would make the provider a gazillionaire. I think I saw two post on the board this week from people it did not work for and no one it worked for. Dr. Z suggested it was somehthing similar to Radio Frequency Lesioning which also kills the nerves in a very specific area. I had this done in my low back with no results. It is an accepted procedure but no big claims of a big success rate. If someone can cure PF 90% of the time with a procedure they should present a paper for peer review at an appropriate forum and proceed from there. If the procedure is safe I would probably try it but I would not expect a 90% probablilty of a cure and from what I have read would not travel out of the state for treatment as I would for ESWT.