This information may interest those who do not want to undergo neuroma surgery.
I have located 2 manufacturers of equipment for cryogenic neuroablation. They are: Westco Medical Corporation and Cryotech LLC.
To find a DPM in your area, get email addresses for the companies and ask for DPMs that utilize their equipment.
For anyone in Middle Tennessee, there is
Dr. Chuck Peter DPM, 1254 Nashville Highway, Lewisburg TN 37091-2222, (931) 359-7677; fax (931) 359-7784.
At this time, Dr. Peter charges $300 for the 15-minute procedure. He claims insurance companies reimburse the entire $300.
Cryotech claims "on-going studies have reported periods of three years and beyond" for pain relief.
Hope this information helps someone out there.

Thanks for the input, Pat. Have you had the procedure done?

Jeff

I just wanted to clarify the information on the cryosurgery. Westco has not been in business for many years and the company does not exist. Cryotech LLC has also gone out of business recently. They may still have a website.
The only company that exists is Cryomed. They are based in Utah and previously in the UK.
http://www.cryomed.us/
The unit for cryosurgery is called a Cryopac.
I personally perform cryosurgery and it is an excellent procedure for neuroma and other painful foot conditions.
Feel free to contact me if you are trying to find cryosurgeons in the US. My site is http://www.tampacryosurgery.com if anyone needs more detailed information.

Hope that helps.

Marc Katz, DPM
Tampa, FL

Hello All (who are affected by Morton's Neuroma).

I'm from Australia and this is the first time I have heard that Morton's Neuroma can be treated by cyrosurgery. I came across it on the web today and I am quite excited by the treatment. However, the problem is that I live in Australia and have had MN for the past 4 months. I originally suffered from Plantar Fasciitis (from September 07) and probably have about a 95% cure from that ailment). Then I was diagnosed with MN [maybe due to the pressure of the ball of my foot being constantly used as a method of walking (instead of my heel)]. I have been given the option of surgery (removal of the nerve of the foot between the second & third toe of my right foot), however, prior to my decision, I saw Dr Katz's webpage and had an instinctive feeling that this treatment may be for me. I have yet to find an Australian surgeon/podiatrist who offers the same treatment. However, I have two important questions :

1) Would Cryosurgery for MN - carried out in USA - be covered by medical insurance companies in Australia? I feel that the treatment sounds as if it would be very successful, however, if it was covered by the Australian Medical Insurance Companies in the USA it would certainly be advantageous for sufferers such as myself.

a) Dr Katz - would you please let me know whether you would be able to assist an Aussie who would be prepared to travel to the US to receive your expertise? This could only be done with the assistance of our Australian medical insurance system.

2) If not, do you know of an Australian surgeon/podiatrist who has the knowledge to carry out this procedure?

I look forward to hearing from you and thank you for your interest and the time you have given to read my email.


Jenny

Thanks for the clarification, Dr. Katz.

Jeff

Hi Jenny and welcome.

Just a couple of subtle points that I'd like to make clear about treating Morton's neuroma. First, many people respond to conservative care of Morton's neuroma. As an example, I saw a patient yesterday who recently graduated from college with a dance major. She doesn't plan to dance as much now that she's out of school. As a result, she's feeling much better with her neuroma. In terms of her treatment, she's a great candidate for a wider shoe, moderation of activity and the use of a felt metatarsal pad. She may require a cortisone injection to jump start the healing, but she's a good example of someone who will respond to conservative, particularly with a change in her activities.

But let's say you fail conservative care. That's when you move into what I call the second level of care for a neuroma. The second level of care would include neuro ablation and external neurolysis. Neuro ablation can be accomplished in a number of ways. To ablate means to simply destroy the internal contents of the nerve. The advantage of this technique is that ablation maintains the outer sheath of the nerve. This is an important distinction when compared to a traditional neurectomy (nerve excision). Peripheral nerve will attempt to grow back. With an ablation technique, if the sheath is intact, the nerve will have an existing conduit in which to regrow. By comparison, without the intact sheath, as the nerve regrows, it grows in a poorly differentiated mass we call a stump neuroma. And a stump neuroma is a common complication of a traditional neurectomy.

Ablation can be accomplished in a number of ways. Dr. Katz uses cryo or cold ablation. I use chemical ablation, using a 4% alcohol injection. The disadvantage of chemical ablation is that it requires a series of 6-7 shots. I've not seen a comparison in the literature between the two techniques, but I'd reckon a guess that the two techniques have similar outcomes. Essentially, you're accomplishing the same thing with a little different method. There's another method of ablation called radio frequency ablation, but I don't see many docs using radio frequency ablation for MN.

Another technique used in level 2 care is a procedure called an EDIN procedure. EDIN stands for endoscopic decompression of an intermetatarsal neuroma. The EDIN procedure is an endoscopic procedure that releases the ligament that binds the intermetatarsal nerve. The EDIN is also a nerve sparing technique and a technique that I use fairly often.

And lastly is the old tried and true neurectomy or removal of the nerve. I can honestly say that I've not done one in years. And I'm just as happy since I would tend to see a fair number of post-op complications. Many neurectomies are done successfully and the neurectomy still is considered a contemporary part of a foot doctors care. But I think in the future that we'll see less and less neurectomies due to all of these other treatment options.

The tough choice though is that there's really no consensus as to which of these procedures is universally best. And that's the point that I wanted to make about cryo surgery. Cryo ablation is a good alternative but really shouldn't be viewed as a distinctly superior method of care. It's a good option in the treatment of MN. But it's not considered the gold standard of care.

If you take a few minutes and search the forum contents for Morton's neuroma posts, what I think you'll find is interesting. What's really most important about Morton's neuroma is the diagnosis. In some cases, there's a tendency diagnose all forefoot pain as MN. And this just isn't always the case. Morton's neuroma may be a only a part of the diagnosis of forefoot pain. So you have to go into treatment with a good diagnosis reasonable expectations of treatment.

Make sense? Thanks for your post. Makes fo good discussion. Maybe we'll get more feedback from Dr. Katz.

Jeff

Hi Jeff
Many thanks for your reply to my query. It seems that there are quite a few options that I'll need to consider before taking any kind of decision. I note that you mention a felt metatarsal pad. My podiatrist has already 'installed' the pad onto my shoe insert and I do get quite a bit of relief from it. I also wear shoes with wide toe boxes and this also adds to the relief. Moderation of activities is now a way of life. I will go ahead and investigate MN more fully on this excellent website and learn more about it. My podiatrist is keen for me to leave my foot alone (ie no cortisone injections or surgery) for another 6 months in the hope that the nerve will settle down. My main concern at this stage is that when walking barefooted, which is now very rare (thanks to the PF), I feel as if I am walking on a stone, however, with shoes and the pad, I can at least, get good relief and can spent a lot of time on my feet.
Many thanks for your advice - it is much appreciated.
Jenny

Dr. Oster: Sorry, it has been quite some time since I've been on the forum. I have made a valiant attempt at getting my own information and, as previously noted, I found a DPM in Lewisburg, TN, who does the cryo surgery for MN. He called me. He told me the cryo technique is only for fairly new MNs. As I have known about mine for several years (remember - I was under-treated), and the MN became acute the end of June, the TN DPM said there is now too much scar tissue (the foot had become swollen plantar and dorsally because the MN was so swollen) and the cryo machine would be only minimally effective due to the scar tissue. So, since the poor folks' clinic I go to has denied me care, I'm attempting to get in with an orthopod, who is a friend of a friend of mine (my friend is a nephrologist who works in the same building). I should know something next week - but I don't know how I would handle the financial end, what with having to be in an out-patient setting. Even though it's with the University of Tennessee Knoxville, they don't owe me any favors. In the meantime, I cannot hike, have a difficult time walking - no pressure on the ball of the foot - and have had to give up a traditional cardio class, where everything is stopping and starting on the ball of the foot. I can still do step, because the instructor cues so well, and I know how and where I'm going to place my foot.
So, if I have the surgery, I shudder to think what the down time will be. One day away from working out and the depression gets so intense I can't function.
I'll try to update you, once I hear from my kidney friend.
Pat

p.s. Just before I wrote to the DPM, I got the cryotech info on-line at its Web site. A rep wrote me, and it sure didn't sound as if it had, or was going to be going out of business. Maybe since then it has.

hikerpat,

Just so I remember correctly...you had a neuroma excised and still have pain. Is that right?

Jeff

No, no excision of neuroma previously. I had 3 sclerosing injections given over 3 months' time (you called it under-treated).
Tennessee doc said too much scar tissue contraindicates use of cryo probe. Do you agree? He has never examined me.
I did not hear back from my friend but expect to see her this coming week. Sure don't know where the money would come from to pay for all this. I'd much rather travel four hours to have cryo done than to be laid up for several weeks with a cast on my foot.