Dr. Katz is pleased to announce that he is taking out of state patients again.  Please read the following guidelines in detail prior to considering a visit to the office.

In an effort to inform our future out-of-town patients, we have provided strict guidelines regarding cryosurgery.  This will also allow our office and Dr. Katz to provide you with this valuable service.  To provide all patients with quality care, we cannot make exceptions.  Everything below is subject to change. Please read all information carefully.  Also see questions and answers section for all of the facts that you will need.

Requirements Before Making Your Appointment

Confirmed neuroma by a physician – send physician notes prior to scheduling appointment

Confirmed plantar fasciitis by a physician with ultrasound confirmation – send notes prior to scheduling appointment

MRI or Ultrasound read by a radiologist confirming neuroma – send prior to scheduling appointment

Prior conservative treatment for at least 3 months by a physician for neuroma or heel pain

Discussion with Dr. Katz prior to booking may be required

Currently cryosurgery is performed only on Wednesday afternoon and Friday morning

Must come in for an exam prior to the day of your cryosurgery

Must be in town for follow-up 2-3 days after your surgery

No cryosurgery will be performed the same day as your initial exam

You may need to be available on Wed and Fri if more than 2 areas are going to be treated

What Types of Problems Can be Treated When Coming from Out of Town?

Confirmed Foot Neuroma and Heel Pain

No chronic pain cases, no neuropathy, no fibroma, no tarsal tunnel

Please note that cryosurgery is about 80% successful.  There are no solid studies that have been performed; however, this data has been gathered by Dr. Katz after performing around 2500 procedures.  As with any procedure, there is a chance that you will have no relief or recurrence of your problem.

What Is and Isn’t Covered and How Does Insurance Work?

All payments are required on the day of your initial exam and on the day of surgery.

We do not accept out of state insurance other than BCBS and Medicare for neuroma cryosurgery, others will pay cash and be responsible for sending in information to their own insurance for reimbursement.  Reimbursement from insurance may be less than the amount you paid. 

Cryosurgery for plantar fasciitis/heel pain is never covered by insurance and will not be submitted to any insurance companies.

Second treatments are either billed to insurance or are 50% of the initial cost

There is a never a guarantee that insurance will pay for you cryosurgery even if we accept your insurance.

The office does not do prior authorizations as insurance companies still do not guarantee payment

You will sign a statement confirming that if your insurance denies the doctors charges that you are responsible for full payment

What Do I Do After Surgery?

Must be in town for follow-up 2-3 days after your surgery

You will need to wear a surgical shoe and padding for 2 weeks

You may be prescribed an anti-inflammatory

Most patients will be required to have custom orthotics and may have them made the same day with Dr. Katz if they do not have a pair or have an inadequate pair.

Return to exercise at earliest 2 weeks and maybe longer.  If you run marathons or triathlons, you will likely need at least 4 weeks off of your activities.

Be prepared to return for a second procedure if necessary

Second treatments will be determined only after 3 months

If there is no relief after the second cryosurgery, you will need to seek another type of treatment

Miscellaneous Notes:

Decreased success rate if you’ve had alcohol injections or traditional surgery

Please note that Dr. Katz may determine that you are not a candidate for cryosurgery even after travelling to Tampa

Please read all information below to be fully informed:

• While it is rare to get worse from the procedure, there is still that possibility. 
• It is possible that you will not have relief from the procedure
• It is possible that you will need more than one procedure
• You will likely be sore the first few weeks
• Your relief may be permanent or temporary requiring another procedure
• You may experience prolonged numbness or feel a thick or ball-like sensation.
• The success rate for cryosurgery has been superior to traditional invasive surgery
• Prior treatments(i.e. Surgery, alcohol injections) may decrease success rates  

Common Scenarios after you Cryosurgery procedure: 

1. At 2-6 weeks after the surgery you will start to feel relief or have significant or complete relief of pain.  
2. At 4-6 weeks after the surgery you are 40-60% better. You may continue to improve over the next 4-6 week period.
3. At 4-6 weeks after the surgery you are 40-60% better. However you may stay at that level after 6 weeks and will likely need another procedure.
4. You are the small percentage that gets no relief at all.  You will be re-evaluated and a decision will be made on repeating the procedure.  

To heal quicker, Dr. Katz will have you:

• Decrease your activities for first 2-3 days after the procedure. 
• If you workout or run, stop for 1-2 weeks
• Wear a surgical shoe and pad for the first 1-2 weeks after Cryo.
• Apply ice for 15 minutes, 2-3 times per day for the first week
• Use anti-inflammatory medication in some cases
• Wear orthotics that he recommends for long-term relief 

 

It is my practice to have open communications with my patients so that expectations are realistic and results are optimal.  Please ask any questions or talk to me about any concerns at any time.

Marc Katz, DPM

Common Questions Asked by Patients

More questions will be added on a regular basis.  If you have questions that are not answered here, please send them to us and we will add them.   We would like this to be as comprehensive as possible.

QUESTION:  What happens to the nerve after it is frozen? ANSWER:  The body will absorb the dead nerve and usually regenerate a new nerve.

QUESTION:  Will I have immediate relief after the procedure? ANSWER:  No, not usually.  It takes time for the nerve to die and also time for the surgical area to heal.  So, don't expect to be pain-free immediately. In some cases people require weeks to heal and need time to assess their total amount of relief.

QUESTION:  Will I need more than one procedure? ANSWER: Depending on your condition and previous treatments, you may require several procedures.  If the pain returns you may also need another freeze.  However, this is more desirable than the traditional procedure.

QUESTION:  Can cryosurgery cause permanent nerve damage? ANSWER:  Of course any procedure that kills a nerve is causing nerve damage. It is possible to get more prolonged damage that may result in continued pain.  That is a risk that you take with any surgery.  This is the case with any type of nerve surgery including the traditional nerve removal procedures which have a higher complication rate.  However, in most cases there is significant relief.

QUESTION:  If I have relief how long will it last? ANSWER:  That will vary with each patient. Since the nerve dies and then regenerates, pain can return after a number months or years.  However, in most case the nerve will regenerate with minimal inflammation and there will be significant prolonged relief. 

QUESTION:  Do all people get relief after cryosurgery ANSWER:  No, as with any procedure you may not get relief and may require additional procedures.  However, the procedure is certainly superior to the traditional surgeries and should be tried before consideration of more invasive procedures.

QUESTION:  How long will I be sore after the procedure? ANSWER:  That will vary with each patient, however some people experience inflammation and soreness for up to 4 weeks.

QUESTION: I've had alcohol injections for my neuroma.  Does that change the success of the procedure?  ANSWER:  Yes it does.  If you have had alcohol injections, the nerve itself changes and becomes more resistant to freezing.  Typically the success for one freeze is around 60% and most people require further freezing after the first procedure.

QUESTION:  Is it possible to have more pain after the procedure? ANSWER:  Since this is a surgical procedure, it is possible to have increased pain and soreness from the procedure.  In some rare cases patients have reported that their nerve pain actually worsened.  In those cases we continue treatments to resolve the pain.  So we are unable to guarantee that you will get relief and not have increased pain.  However, it is important to note that the standard procedures have more complications and a greater chance of problems and worsening symptoms.

QUESTION:  Does having this procedure preclude having regular surgery at some future date if it were deemed necessary?
ANSWER:  No, this is not an issue at all.  There will be nothing removed surgically from your foot.  This is a natural freezing process and you could have traditional surgery without any issues in the future. 

QUESTION:  What about having a second cryosurgery if the first doesn't do the job? 
ANSWER:  A second procedure is sometimes needed and can be done without problems; however the time between procedures is likely several months.

QUESTION:   What are the risks associated with cryosurgery?
ANSWER:   They are the same as any surgery but since the cryosurgery procedure is minimally invasive, complications are rare especially when compared to the traditional surgeries for heel pain and neuroma.  Infection, abscess and worsening pain are a few possibilities.  However, again these would be extremely rare.  Numbness may be a common side effect but is not considered a complication.

 
QUESTION:   If I have had this pain for 2 years, can the cryosurgery still help me?  I was told some treatments might not help because of the length of time I have waited to do anything. 
ANSWER:   Many of the people I treat have had their pain and problem for years.  Cryosurgery is an excellent treatment regardless of the time that you have had the problem.  In resistant cases, you may need more than one treatment.  

 
QUESTION:   I have a neuroma.  If the neuroma increases in size, how do you know if it’s too big for the cryosurgery to work?  
ANSWER:   The neuroma can only grow so large and can be frozen at the thinner portion of the nerve behind the enlargement.  Also, it is possible to treat several areas of a nerve.  If the nerve has scar tissue and is more resistant to freezing, you may need the procedure repeated.

QUESTION: What is the difference between surgery to cut the plantar fascia and cryosurgery?  ANSWER:  The procedures are very different and unrelated.  When the fascia is released, you are basically cutting the strongest ligament in the body.  This is the major support structure in the foot!  This is considered a more involved, more major foot surgery.  So if it was my foot that would absolutely be my last option.   I do not do them any longer because the effects of cutting this strong band can often be problematic.  
With Cryosurgery, I would be disabling the nerves to the area of pain.  The theory is that when the heel is inflamed, the nerve gets trapped and damaged.  Also, there is a pain signal to the spinal cord that is disrupted after the freezing.  As a colleague of mine once suggested, it is rebooting the nerve, just like a computer reboot.  Also there would be super freezing which removes swelling.

ANSWER:  Yes, It could return no matter what type of procedure or treatment you have, even with a major surgery.  Cryosurgery is a highly successful, minimally-invasive procedure with excellent results.  If necessary it can be repeated.  In addition, I always recommend wearing orthotic arch supports for the future to prevent recurrence by correcting the foot structure and decreasing the stress on the foot that caused the original problem.