Morton's Neuroma is a pathological condition of the common digital nerve, most frequently between the third and fourth metatarsals (third inter-metatarsal space). The nerve sheath becomes abnormally thickened with fibrous (scar) tissue and the nerve fibres eventually deteriorate.
The technique involves the use of a cryoprobe which at its tip forms a 6-8mm ice ball that reaches temperatures as low as -67°C. The cryoprobe tip destroys nerve tissue by causing extensive vascular damage to the nerve sheath capillaries. This then causes demyelinazation (breakdown of the myelin sheath) and degeneration of the axon.
An important feature of this technique to appreciate is that the essential aspects of the nerve chiefly, the epineurium and the perinerium remain intact, therefore preventing the possibility of formation of a stump neuroma.
At this point in time there are approximately 140 Podiatrist using this Cryo technology. Over the last eight and a half years more than 42,000 procedures have been performed collectively. The success rates range from 80-97%.
The obvious advantages of cryo injection therapy over conventional surgery are:
- The procedure is performed in the clinic setting not hospital.
- No stitches are required.
- There is a 7 –minute treatment protocol.
- There is no need for opiate based analgesics.
- There is no postoperative neuritis neuralgia pain.
- Patients can walk out of the clinic with their own shoes on as opposed to a surgical post-operative boot.
- There is generally little or no post treatment neuroma pain and only mild bruising in the forefoot lasting 4-5 days.
- Patients are able to return to work usually with-in 24-48 hours wearing only a plaster over the puncture site.
- There is a high success rate and wide patient acceptance.
- An almost none-existent risk of stump neuroma formation.
The majority of patients obtain complete relief or significant improvement immediately following cryo injection therapy. When no relief occurs, it is usually because of dense scar tissue related to previous excisions of the neuroma; however inserting the cryoneedle through the plantar (underside) aspect of the foot can often overcome this. The ice ball is thought to destroy a one cm portion of the nerve which can regenerate at between one to three millimetres per day; therefore the axon regeneration should be complete within several weeks. It appears the long lasting relief is due to the reduction of neural oedema and nerve sheath fibrosis of the neuroma.
Similar long-term relief has also been reported with the use of Cryo injection therapy in the treatment of painful trigeminal nerve pathology.
Cryo injection therapy is a relatively new treatment option and very much a cutting edge technique. It was introduced three years ago in the United States, therefore no long term data exists as to whether cryo injection therapy can considered to offer a permanent cure. However Podiatrists in the Unites states report that 80-85% of patients have so far reached the three year mark with no reoccurrence of symptoms.
Are there any complications associated with Cryo Injection Therapy?
There is a very low incidence of complications associated with cryo injection therapy. Infections are rare, as is abscess formation at the puncture site. All patients who have had Cryogenic neuroablation have maintained full motor function with no greater loss of sensation then they had prior to the procedure. If patients are unlucky enough to experience a return of symptoms at the one or two year point the procedure can simply be repeated. Cryo injection therapy has been approved by the FDA, a branch of the United States government that regulates foods drugs and medial procedures and equipment. The Cryo injection therapy equipment at the Barn Clinic has also received a European Union ‘C.E’ mark for the treatment of neuroma and plantar fasciitis.
Can anyone have cryo injection therapy?
Obviously cryo injection therapy involves very cold temperatures, therefore this procedure is not offered to those patients with poor circulation or peripheral vascular disease or conditions such as chilblains or Raynaud’s Phenomena.
Cost
The costs of ongoing training, running and maintaining cryo injection therapy equipment is high and provides little cost savings over conventional neuroma surgery costs.
I am interested in this procedure, is there a waiting list?
The current waiting time for cryo injection therapy is 2-3 weeks. Please do not book a routine clinic appointment in the expectation that the procedure can be performed immediately, if you are travelling from afar we are happy to offer advice on airport transfers from Manchester or Doncaster airports.
