Question
Hello,

I抳e been considering cryosurgery for a morton抯 neuroma and I抳e been doing some research about the procedure. I抳e read that there are different approaches to cryosurgery.

Could you tell me what the difference between a top or bottom (webspace) approach is?

What does 搃nserting the cryoneedle through the plantar aspect of the foot?mean?

From another message board I gathered this comment: 揇r. John DeBello and his group from NYC told me they have almost 100% success rate coming through the interspace. It just does not always work in my hands. I believe you need to treat proximal behind the met heads as well as distally in the sulcus.?br>
What do these terms mean and is there any significant difference between these different styles of approach?

Thank You,

Jenna


Answer
Hi Jenna,

There are several approaches for the Cryosurgery probe in the foot.  
The top approach goes through the thinner skin behind the toes and behind where the large joints bend.
The webspace approach is done from the bottom of the foot, also known as the plantar(plantar aspect) approach.  This involves going through the webspace which is basically between the toes on the bottom of the foot.

I have and still use both approaches in different situations.  I would say that the top approach in my hands has produced excellent results.  I can tell you that anyone stating that they are getting 100% success has to be out of touch.  There are no foot procedures or treatments that always work for everyone all of the time.  That is just unrealistic.  

The comment  "proximal to the met heads". refers to the top or dorsal approach.  I have not found the need to freeze in a second spot, "as well as distally in the sulcus".  This approach has been used to increase the chances of freezing the nerve, so there are 2 separate areas frozen.

My method is different.  I will use a nerve stimulator and can locate the nerve to be frozen.  I also perform this under ultrasound guidance when I am able to get a good view of the neuroma.  This requires only one area to be frozen.  This has produced outstanding results.

The two different approaches are both good techniques.  Each surgeon will have their own preference.  There are even some new approaches that I've developed that have been promising.

I personally have found that using the nerve stimulator produces better results.  Some Drs. will find the point of most tenderness and freeze that area.

So its all good in the right hands.

Hope that helps.

Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
www.tampacryosurgery.com
www.thetampapodiatrist.com