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I am 68 years old male in good general health.

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Posted on Mon, 25 Mar 2019
Question: I am 68 years old male in good general health. I had shingles about 10 years back. I got PHN in left bootom front foot. I got inflammed nerve under my left foot where there is normally Mortons neuroma. I had cryo surgery and it was almost pain free for 7 years. Recently the pain has come back. It is tolerable but very irritating. I had ultra sound of the foot. It showed no mortons neuroma but showed inflammed nerve in the same location. I am planning to have cryo surgery again.

In first cryo surgery, the doctor inserted the cryo from the bottom of the foot which touches the ground. The present podiatist says he will insert from the top and not the bottom to avoid scar tissue.My questions are:

1) What are the significant risks for going from the top? Is it better than going from the bottom.

2) Can you hit bones or nerves by going from the top?

3)Can I get foot drop by going from the top.

4)Is this cryo surgery very risk free? I can tolerate the pain but it is a regular problem.

5) Any other approach for the pain? I have already tried lyrica, lidocaine, CBD cream etc.
Thanks for your response.
doctor
Answered by Dr. Salah Saad Shoman (6 hours later)
Brief Answer:
No

Detailed Answer:
Dear sir, I have gone through your question and I understand your concerns but there is no need to worry as the top and bottom results have comparable results .. They should be performed under guidance of an imaging device to avoid injury to any anatomical structures..
Risks of cryotherapy include irritation of near by structures or numbness , however they are mostly temporary..
Other approaches include analgesics to relive the pain along with vitamin b12 supplements.. That is why I would recommend that you get a blood test for vitamin b12 level to exclude it’s difficiency first before cryotherapy. I hope you find this helpful
Above answer was peer-reviewed by : Dr. Nagamani Ng
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Follow up: Dr. Salah Saad Shoman (13 hours later)
Thank you for your response.

I had previously taken substantial vitamin B12 but it did not help. My daily multi vitamin has 400 percent of RDA for B12.

My Podiatist will freeze the nerve at 2 places. He will go from the top at 2 places. The nerve location is same as that of mortons neuroma but little bit longer. In the location where the cryo probe will go in, are there any critical nerves? Are there any critical structures? What is the worst case.

The doctor will use an imaging device.

Thank you.
doctor
Answered by Dr. Salah Saad Shoman (25 hours later)
Brief Answer:
No, please don't worry

Detailed Answer:
Dear Sir, Hello again...

It is very unlikely to cause damage to major nerves as the procedure is guided by an imaging technique to avoid any possible effect of anatomical structures...

However possible complications include inflammation of nearby tissues or numbness and tingling sensation; both of which are temporary in most cases.

I hope you find this helpful

Kind regards


Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Answered by
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Dr. Salah Saad Shoman

Internal Medicine Specialist

Practicing since :2004

Answered : 2503 Questions

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I am 68 years old male in good general health.

Brief Answer: No Detailed Answer: Dear sir, I have gone through your question and I understand your concerns but there is no need to worry as the top and bottom results have comparable results .. They should be performed under guidance of an imaging device to avoid injury to any anatomical structures.. Risks of cryotherapy include irritation of near by structures or numbness , however they are mostly temporary.. Other approaches include analgesics to relive the pain along with vitamin b12 supplements.. That is why I would recommend that you get a blood test for vitamin b12 level to exclude it’s difficiency first before cryotherapy. I hope you find this helpful