Frequently Asked Questions

Is cryosurgery painful?

Cryosurgery itself is not painful because your will receive a local anaesthetic. This anaesthetic is generally injected into the ankle and top of your foot, not at the site of the neuroma. Here the skin is relatively soft and the injection is generally tolerated very well. Most patients find these injections less painful than a dental injection.

How long does cryosurgery take?

Your entire appointment will be one hour and this includes the time it takes for your foot to go numb following the administration of local anaesthetic.

What will I need to do after the procedure?

We recommend that you travel home on the back seat of a car so you can keep your foot elevated. You should rest for 24 hours but can then return to work. You should avoid longer periods of walking (short walks of 10 minutes or so should be fine).

When can I go back to sport?

We generally recommend that you wait 2-3 months but this does vary from patient to patient and individual response. Best to call the clinic to discuss your progress so we can give you individual advice.

What is the typical time before I know the procedure has worked?

You should give the procedure 3 months to work. However, the response to treatment does vary from patient to patient. The most important thing is to 'listen to your body' and to do as much or as little according to your comfort levels. If you have little to no pain after 2-3 weeks then you will clearly be able to do more than if your foot still has some tenderness.

Why do people respond in different ways in terms to their recovery from cryosurgery?

Some patients bleed and bruise a little more than others. Pain thresholds vary from patient to patient and some patients (especially those with hypermobility / double jointedness) may be more sensitive to surgery.

What is the risk of complication from cryosurgery?

The incidence of complication is very small and to date (August 2014) not patient at the centre has suffered a significant complication such as infection. Please however read our foot surgery booklet.

Is cryosurgery experimental?

No. Cryosurgery has been used to treat various conditions for over 25 years. Those using it for Morton's neuroma declare good success rates. More evidence is needed and this is why the London Podiatry Centre formally audits its results. Our results are similar to those often cited in the United states, at 70-80%.

Does the procedure work after failed open surgery?

Patients who have failed open surgery may respond to cryosurgery by freezing the distal hypersensitive part of the remaining nerve. This may be imbedded in scar tissue or present as a stump neuroma

What if I've had failed steroid injections?

The Centre often treats patients who have already tried a steroid injection. A single previous injection will not necessarily reduce the chance of cryosurgery working but multiple failed injections can lead to complications such as soft tissue wastage which can reduce the potential benefit of cryosurgery

Is the procedure covered by private medical insurance?

This depends on your insurance company and its best to call our centre to discuss this.

Will I have permanent numbness?

Patients can have reduced sensation in the toe but but this usually does not last indefinitely.

Can I have more than one foot treated at a time?

This depends on your specific circumstances but often we prefer to treat a single neuroma. Diagnostic injections can be performed at the centre to identify whether more than one neuroma requires treatment. We prefer to not treat two feet at the same time as this can slow recovery.

I've been told I have a bursa and a neuroma, will cryosurgery address both?

A bursa and neuroma usually present together and cryosurgery can be used to successfully treat both. However if a very large bursa is present then a steroid injection may also be indicated.

Are the effects of cryosurgery permanent?

Many patients do not appear to have recurrence after cryosurgery, however this is possible. Our audits show that only a very small percentage of patients require a second treatment.

How much hard evidence is there that cryosurgery works?

There is a shortage of good medical studies and the centre is actively involved in auditing its results. Most practitioners using cryosurgery state success rates of between 70% and 80%. You may be surprised to read that there is no good evidence to show that cortisone is effective in the long term management of the condition despite its routine use in the treatment of Morton's neuroma.

Why is cryosurgery not offered more generally in the UK?

It is true that the procedure is more established in the United States. The equipment costs are high and one has to invest a significant level of time and training with a high learning curve. Given the obvious benefits of the procedure over open surgery, it is very likely that many more practitioners will offer the treatment in the future.

Do all practitioners offering cryosurgery have similar qualifications?

No. We would recommend that the procedure is performed by a Consultant Podiatric Surgeon. This is your guarantee that your podiatrist is highly qualified and capable of managing all aspects of your problem.

Should I consider cryosurgery before other types of surgery?

We would certainly recommend that you consider cryosurgery before open surgery because of the reduced risk of complication and shorter recovery time. Some patient like to try a steroid injection and this is reasonable although the benefits are often short term.

How much does cryosurgery cost?

Please call the centre for more information.

Do I need to stop any of my medication before receiving cryosurgery for Morton's neuroma?

Whilst most drugs can safely be continued during cryosurgery there are a few which can interfere with the procedure. Only ever change your medication after first discussing this with your GP or the specialist who has prescribed them. Below is a list of the medication that could influence the healing process. Please contact The Centre if you require further information.

Aspirin

This medication may cause some increased bleeding during cryosurgery, although the risk is fairly small and generally patients can continue with aspirin if they wish to. However, for those patients who are taking aspirin without a strong medical indication, we would suggest that you abstain for a week before the procedure.

Clopidogrel

This is an antiplatelet drug which is often prescribed for heart and other vascular conditions. This drug should not be taken during cryosurgery and we would recommend that it is stopped 10 days before the procedure. We would strongly advise that you discuss this with your cardiologist or GP first.

Warfarin

It is not considered safe to have cryosurgery for Morton.s neuroma whilst on Warfarin, particularly if you are taking an amount which causes your INR to be raised above a level of 2. Generally speaking for cryosurgery we would wish your INR to be between 1 and 1.5. For patients on Warfarin they would need to convert to low molecular weight heparin a few days before their operation to reduce the risk of adverse bleeding. The Centre is happy to liaise with your GP or haematologist to facilitate this and an expert opinion from these individuals may be required before the procedure can take place.

Methotrexate

This drug is often given for the management of a condition called rheumatoid arthritis or other forms of inflammatory arthritis. Opinions vary from rheumatologist to rheumatologist and some are quite happy for cryosurgery to take place without adjusting your Methotrexate dose. However, we would always recommend that you discuss this with your Consultant Rheumatologist first. Methotrexate belongs to a group of drugs called DMARDs (Disease-modifying antirheumatic drugs). There are others in this group and we can give specific advise via The Centre should you require further information.