Cryosurgery Used for Chronic Foot Pain

BRADENTON, FLA. -- For those with chronic foot and/or heel pain, Dr. Brent Rubin has a suggestion: Give it the deep freeze.

Rubin, a podiatrist at HealthCare America, isn't advocating that pain sufferers immerse their feet in a bucket of ice cubes. Rather, it's cryosurgery -- an ancient concept that uses super-cold temperatures to treat inflamed or diseased tissue.

"It literally freezes the nerve," Rubin said of the procedure, which he has performed on about 150 patients. "It doesn't kill it permanently. The nerve will regenerate anywhere from six months to a year later."

And, it usually heals itself in the process, thereby eliminating the source of the pain, he said.

The procedure is minimally invasive and can be performed in a doctor's office in less than 30 minutes.

It's also virtually painless, with the only pain usually coming from the initial injection of local anesthesia, Rubin said.

After the area is numbed, a small incision is made and a tiny probe is inserted. The probe contains a neural stimulator, which is used to isolate the damaged nerves, and a freezing tip.

Nitrous oxide gas is passed and withdrawn through the tip, forming an "ice ball" that freezes the nerve tissue with temperatures as low as minus-130 degrees Fahrenheit.

The process, which is done in two- to three-minute bursts with 30-second thawing periods in between, deadens the inside of nerves but doesn't damage the outer shell, Rubin said.

With the nerves "dead," they can't send pain signals to the brain.

"That's the beauty of it," Rubin said.

After antibiotic ointment is applied on the incision, which is covered by gauze and a pressure bandage, patients are told to take it easy on their feet for a few days -- as they walk out of the office.

That's what Lake Erie College of Osteopathic Medicine student Randy Scott did recently.

Scott, an avid runner, said he began having pain in his right heel about eight months ago. He initially treated it with over-the-counter pain relievers and anti-inflammatory medicines, but the pain worsened.

"It wound up where I could run maybe every couple of days instead of every day," he said. "Then my heel would hurt when I got up in the morning. Then it progressed to where it was hurting the rest of the day."

He went to Rubin, who diagnosed the problem as plantar fascitis -- inflammation of the tough, fibrous band of tissue that connects the heel bone to the base of the toes.

Rubin initially prescribed a conservative course of treatment that included orthotic insoles. When that wasn't effective, he suggested Scott undergo cryosurgery.

Scott said the procedure lasted about 20 minutes, and he walked out of the office immediately afterward.

"It's sort of like getting stitches, in that the only pain that you feel is the injection of lidocaine," he said. "It was painless, pretty much. Very little discomfort."

Scott said his heel has been pain-free since, even after doing 12-hour emergency room shifts.

Besides plantar fascitis, cryosurgery also can be used to treat diabetic neuropathy, neuromas (nerve tumors) and tarsal tunnel syndrome, compression of a foot nerve similar to that of carpal tunnel syndrome in the hand, Rubin said.

He estimated 90 percent of his patients who've had the procedure experienced the elimination or substantial reduction in pain.

But cryosurgery should not be the first course of treatment, he said.

"It's a last resort when everything else conservative has not worked," Rubin said. "The purpose of cryosurgery is to avoid major surgery."

Not a New Technique

The concept of cryosurgery -- which comes partly from the Greek word for "cold" -- isn't new.

In the mid-19th century, a British physician reported using the super-cold gas to treat breast and uterine cancer, according to several articles on the history of cryosurgery.

It's now widely used as a pain management tool, to destroy precancerous cervical cells and to treat localized prostate cancer, among other applications. Dermatologists also use cryosurgery to remove warts and treat age spots.

But it wasn't until 2003 that the U.S. Food and Drug Administration approved its use for treating foot pain, Rubin said.

The procedure usually costs around $500 and is covered by Medicare and most insurance plans, Rubin said. Potential side effects are rare and usually mild, and can include infection of the incision site; bruising and swelling; fluid buildup and the formation of scar tissue, he said.