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Cryosurgery for P.F.

Posted by Ralph on 2/01/05 at 10:37 (168238)

Does anyone know where I can read any published articles about this procedure specificly for P.F.? I'd like to learn more about it.

Is it a one shot type of treatment?

Re: Cryosurgery for P.F.

Dr.Wishnie on 2/01/05 at 12:42 (168247)

Hi Ralph:

I am only one of two doctors in NJ that does this procedure. This is usually a one time procedure but occasionally needs a second treatment. You can get info on my website at http://www.stopfootpainfast.com .

In addition, articles by L Fallat in the Journal of Foot and Ankle Surgery, 41:286-290 called 'Cryogenic Neuroblation for the Treatment of Lower Extremity Neuromas, is a good article. Cryoablation has been done for over 40 years on certain cancers like prostate and liver. There is a new article by Dr. Steven Goldstein for plantar fibromatosis. I believe it is in last month's Podiatry Today. If you would like me to get you these articles, I can dig them up and mail you a copy. Dr. Wishnie

Re: Cryosurgery for P.F.

Dr. Z on 2/01/05 at 17:59 (168268)

As Dr. Wishnie states there is a case study for plantar fibromatosis in Podiatry Today. I don't of any peer reviewed orthopedic or podiatry journal. that review whether Cyrotherapy is effective for plantar fasciitis. Dr. Fallet of Detroit has done some studies for pf with cryotherapy and reported a retroactive report.
I do know that Cryotherapy is indicated at this time for only sensory nerve disorders ie neuroma's. Plantar faciosis is a degenerative tissue disease and typically isn't a sensory nerve disorder however there are exceptions to and cryotherapy may be very helpful in cases . Take a look at Dr. Wishnie's information if may be helpful to you.

Re: Cryosurgery for P.F.

Ralph on 2/01/05 at 19:11 (168275)

There isn't much on this site about this procedure from patients who have had the treatment. I was hoping for a lot of positive feedback from those that tried it, but few people here have had it done that's why I am interested in reading about it's specific use for treating P.F. Different doctors use different names Cryoablation, Cryoanalgesia and Cryosurgery but I think you all mean the same procedure right?

My P.F. is located all over my arch areas and toward the outside of my feet not the inside. There must be more nerves involved in such a large area as compared to a neruoma so I don't understand how one treatment works for something like P.F. Which nerve or nerves get treated?

Would I be better off to try ESWT first?

Re: Cryosurgery for P.F.

Dr. Z on 2/01/05 at 19:32 (168279)

The terms are all the same. The question that I first would like to know is why do you think that your problem is plantar fasciitis.? The area that you are talking about isn't typical plantar fasciitis . ESWT isn't indicated for wide areas of plantar fascia pain. It is indicated for discrete ( isolated) pain at the insertional area of the plantar fasica. This is usually the medial band .
It sounds like you may have posterior tibial tendon dysfunction.
Do you have lower back problems or any other joint pain.

Re: Cryosurgery for P.F.

Dr. Wishnie on 2/01/05 at 22:31 (168292)

Hi Ralph:

The terms do mean the same. If the PF is not insertional, meaning not attached to the bone, then ESWT is not indicated. Cryosurgery will treat all areas of pain that you have in one treatment. Each area of pain gets treated with two 3 min. freezing cycles followed by a 30 sec. thawing. We are treating the nerve endings of the peripheral nerves. We are not destroying the nerves, we are just preventing them from exhibiting a pain sensation. You will still have feeling and will have pain if you get an injury to the area. A lot of outside foot pain is due to compensation from the inside area of the foot where you have the problem. PF usually affects the medial or inside band. Thus, the person walks more on the outside of the foot than the inside causing a bruising in the area. Sometimes this is more painful than the PF, especially when the PF becomes improved. I will see if I can get you some success stories on the cryo.

Re: Cryosurgery for P.F.

Ralph on 2/02/05 at 15:26 (168333)

Hi Dr. Z,
Well I thought my problem was P.F. because the Pod. I went to told me that's what my problem was and I was given orthotics. They are in my closet because I could never wear them. After reading about taping, here that's what I'm doing.

I do have a small back problem that was worked up a year ago maybe a little longer. I get some pain in my lower back every now and then. The nerve tests showed a diminished response in one of the nerves on my left side in that area, but nothing major going on according to the doctor.

Because the pain comes and goes he suggested that unless it really became a problem that I do nothing. He gave me exercises to do and said to come back if and when it really begins to bother me regularly. So far so good. Like before it comes and it goes. I haven't have it act up in months so I haven't gone back for any check ups or anything. Figured let well enough alone.

Outside of that and the problem in my feet I'm ok. I sure like this site
because it gives me hope that my foot pain will go away. I have a desk job and good insurance, so I feel lucky especially when I read posts from others.

Re: Cryosurgery for P.F.

John H on 2/03/05 at 14:19 (168413)

Where might one find a list of Doctors who perform this type of Cryosurgery Dr. Wishnie? What are the possible side effects of this procedure and approximte cost. Any data on the success rate for treating PF? How long will a treatment last?

Re: Cryosurgery for P.F.

John H on 2/03/05 at 14:52 (168416)

Ralph it seems to me that if there is a procedure that will cure PF it would be widely circulated and well known among most Doctors. It would be rapidly adapted by many Doctors as we have an estimated 6 million new cases of PF each year. It seems every year or so a new procedures shows up on this board. I am usually skeptical but in fact try a lot of things that my good sense tells me is a waste. ESWT is a widely used procedure with supporting data. It works for some and not for others and not much downside except cost. I would like to know more about cryosurgery for PF but remain skeptical. If I can find any supporting data I am one who will try most anything (except surgery through a scope).

As you know the most common location for PF is on the inside of the foot where the band of fascia from the great toe joins the heel. Of course many people report pain in various places. One of the major problems with PF is locating the Pain Generator. Fact is in most cases we do not know what the pain generator is in PF. Dr. Baxter (Guru from Houston) suggest it is pain caused by pressure from the PF pressing on the Baxter Nerve. His surgical procedure addresses this problem and works for some and not for others. The conventional thought seems to be the pain is caused by a chronically inflamed fascia. Short of doing some pathology you really do not know that. Because we really do not know what is causing the pain we have many treatments going on and none of them are 100% effective. We have ESWT, open surgery, closed surgery, surgery through a scope, cryosurgery, surgery that releases the entire fascia and surgery that releases only part of the fascia,lengthing various muscles, exercise, ice, PT, tape, foot in a cast,orthotics, to many types of muscle manipulation to even list, shots, salves,meds and on and on and on. Each of us have to search and try what is out there hoping we find the magic bullet for our particular situation. I continue to think that what we call PF is a number of diseases with the only common denominator being pain, thus there will never be one treatment that works for everyone. This is like searching for the Holy Grail. I would like to see a large scale study done on feet using tissue pathology. This would be done on feet of known persons who had chronic PF. I have seen a few studies on cadevars but with not enough cases to have any statistiscal reveleance. Not only that, they did not know if the feet were from people who had PF. We really seem to be largely flying blind. Since 90% of all cases of PF are reported to be cured with minimal care we do not have enough chronic cases to get research in this area. Not enough money involved.

Re: Cryosurgery for P.F.

Dr.Wishnie on 2/03/05 at 15:32 (168425)

Hi Ralph:

Cryosurgery has been around for over 40 years but just has been FDA approved for foot problems in the last year. There are only about 20 of us doing it around the country. Same as for ESWT. I was only the third doc in the US to do ESWT about 4-5 years ago. Now it is a household word. The same will happen with this. Cryosurgery is better for nerve entrapments or nerve pain then ESWT, because ESWT does not treat this. A treatment takes 15 minutes and most insurances do cover this. Side effects are one, in might not work in 10 percent of the cases and two I would guess infection, but have not heard or seen one.