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Posted by Casey H on 3/26/05 at 12:41 (171983)

Have had two TTS surgeries. First surgery 6 years ago, became more painful. Repeat TTS surgery 4 years ago by different doctor, with no improvement, recovery was long and painful. Vein wrap done 19 months ago in Baltimore. Still very painful, with pain going up to knee. The nerve itself is scarred according to this last doctor. Amputation suggested by doctor that did vein wrap. Cryosurgery has been suggested by the doctor that did second TTS release. If it isn't advisable to cut the Tibial nerve, why would freezing it be better?

Re: cryosurgery

Dr. Z on 3/26/05 at 15:09 (171992)

It is possible that they are only talking about sensory branches and not the motor tunk of the nerve. You should only have the sensory nerves treated . Dr. Wishnie on this board may be able to better explain this to you. He is involved with using Cryotherapy for TTS

Re: cryosurgery

Dr. Wishnie on 3/27/05 at 07:01 (172016)

that is correct. you are only treating the sensory branches, meaning that the branches of nerves that are sensing pain. These nerves regenerate. They regenerate with 'Alzheimers' meaning they forget they ever had the pain. Cutting any nerve can lead to major problems such as formation of neuromas, growths on the nerve and severe pain. Cutting the motor branches will lead to the lack of function of certain muscles.

Re: cryosurgery

elliott on 3/27/05 at 13:34 (172026)

Dr. Wishnie,

Could you elaborate on the use of cryosurgery for TTS? In particular, if one has entrapment of the post tib nerve at the medial ankle, what are you going to freeze: medial calcaneal nerves? first branch of the lateral plantar nerve? Also, in the case of the poster you responded to, it seems Casey's post tib nerve has gone haywire from ankle up to knee. Where would the cryo be applied in that case?


Re: cryosurgery

Mar on 3/28/05 at 16:44 (172072)

Hi Dr. W -

So if the nerves regenerate and there is still a problem with the fascia (inflammation or whatever), then the pain would return? How long before the nerves regenerate? Mar

Re: cryosurgery

dr wishnie on 3/29/05 at 11:11 (172107)

The pain does not have to return. Again, the nerves regenerate without the feeling of pain. These nerves regenerate at a rate of 1 mm per day. The entire nerve is not being damaged. The endoneurium and perineurium are preserved.

Re: cryosurgery

Casey H on 3/29/05 at 19:00 (172133)

please explain what the endoneurium and perineurium are. From the 'neurium' part it would seem to be related to the nerve. How can the freezing help the pain up to the knee? What are the risks?

Re: cryosurgery

Mar on 3/30/05 at 06:54 (172154)

1 mm per day -- how big are the nerves? How many days, weeks, months does it generally take? And I guess it means the pain CAN return? Are there any stats for what percentage of those treated have pain return? Mar

Re: cryosurgery

Mar on 3/30/05 at 07:13 (172155)

Nevermind - I found the info on the internet - can take up to 10 weeks to regenerate the nerve and there is the potential that pain will not return. Correct? Mar

Re: cryosurgery

Dr. Wishnie on 3/30/05 at 15:33 (172193)

this is correct.

Re: cryosurgery

Mar on 3/31/05 at 09:26 (172260)

Dr W -

Any stats on total, permanent pain relief from cryosurgery? Or on length of time the pain relief lasts? Mar