Dr. Katz answers questions regarding cryosurgery on a daily basis.  He has compiled the most common questions and answers to help you be a well informed patient and to understand the details of the procedure.  HOTELS This is provided as a courtesy.  We make no specific recommendations.  Hyde Park Hotel 2105 West Bristol Avenue, Tampa, FL 0.5 mi SE (813) 254-2000 ‎ · hotelinhydepark.com Best Western Tampa 734 South Dale Mabry Highway, Tampa, FL 1.0 mi W (813) 490-2378 ‎ · book.bestwestern.com Quality Inn Airport 1020 S. Dale Mabry, Tampa, FL 1.1 mi W (813) 254-3005 ‎ · qualityinn.com Hyatt Regency Tampa 211 North Tampa Street, Tampa, FL 2.0 mi E (813) 225-1234 ‎ · tamparegency.hyatt.com Courtyard Tampa Westshore/Airport 3805 West Cypress, Tampa, FL 1.4 mi NW The Westin Tampa Harbour Island 725 South Harbour Island Boulevard, Tampa, FL 2.1 mi E (800) 656-4395 ‎ · starwoodhotels.com Marriott ExecuStay Apartments,Hyde Park Walk - Tampa 800-south Dakota Ave, Tampa, FL 0.8 mi E (813) 890-7225 ‎ · execustay.com     Embassy Suites Tampa - Downtown Convention Center 513 S. Florida Avenue, Tampa, FL 2.0 mi E (813) 769-8310 (Fax) ‎ · embassysuites.com Doubletree Hotel Tampa Westshore Airport 4500 West Cypress Street, Tampa, FL 2.1 mi NW (866) 701-5567 ‎ · tampadoubletree.com     Sheraton Tampa Riverwalk Hotel 200 North Ashley Drive, Tampa, FL 1.9 mi E (813) 223-2222 ‎ · sheratontampariverwalk.com     Howard Johnson Plaza Tampa-Downtown 111 West Fortune Street, Tampa, FL 1.8 mi NE (813) 223-1351 ‎ · tampahjp.com Howard Johnson Hotel - Tampa Airport/Stadium 2055 North Dale Mabry Highway, Tampa, FL 1.8 mi NW (813) 875-8818 ‎ · hojotampa.com Ramada 1200 North Westshore Hotel, Tampa, FL 2.4 mi NW (813) 282-3636 ‎ · ramada.com Tampa Airport Marriott Tampa International Airport, 4424 N West Shore Blvd, Tampa, FL 2.1 mi E (813) 879-5151 ‎ · marriott.com     Hilton Tampa Airport Westshore 2225 North Lois Avenue, Tampa, FL 2.2 mi NW (813) 879-3264 (Fax) ‎ · hilton.com Embassy Suites Tampa - Airport/Westshore 555 North Westshore Boulevard, Tampa, FL 2.2 mi W (813) 875-1555 ‎ · embassysuites1.hilton.com     Howard Johnson Express Inn Suites - South Tampa/ Airport 3314 S Dale Mabry Hwy, Tampa, FL 2.0 mi SW (813) 832-4656 ‎ · hojo.com Wyndham Tampa Westshore 700 North Westshore Boulevard, Tampa, FL 2.4 mi W (813) 287-8275 (Fax) ‎ · wyndhamhoteltampa.com     Extended Stay America Tampa - Airport - West Shore 4312 W. Spruce Street, Tampa, FL 2.2 mi NW (813) 873-2850 ‎ · extendedstayamerica.com Sheraton Suites Tampa Airport 4400 West Cypress Street, Tampa, FL 2.0 mi NW (813) 873-8675 ‎ · starwoodhotels.com     Hampton Inn & Suites Tampa/Ybor City/Downtown 1301 East 7th Avenue, Tampa, FL 3.1 mi NE (813) 247-6700 ‎ · hamptoninn.hilton.com Hyatt Place Tampa Airport/Westshore 4811 West Main Street, Tampa, FL 2.5 mi NW (813) 282-1037 ‎ · tampaairport.place.hyatt.com Villa De Leon 16 Davis Boulevard, Tampa, FL 1.8 mi E (813) 251-1609 ‎

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.

What is the first requirement and why is there a charge?
Dr. Katz will need to review your records and possibly speak to you prior to you being considered as a good candidate for cryosurgery.  There will be a charge for review of records and for the extra time and considerations required for scheduling.  This fee will be required up front and will apply to your Cryosurgery package price if you do have the procedure.
This helps everyone involved to make sure that you are the correct candidate and will have the best outcome.  This will help avoid a costly trip and the possibility of being a poor candidate once you come to Tampa. Dr. Katz will not perform the procedure on poor candidates even if you have travelled here.

Requirements Before Making You Appointment
Confirmed neuroma by a physician – send physician notes prior to scheduling appointment
MRI or Ultrasound confirming neuroma – send prior to scheduling appointment
Prior conservative treatment for at least 3 months by a physician for neuroma
Discussion with Dr. Katz prior to booking may be required
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 2 seperate days if more than 2 areas are going to be treated

What Types of Problems Can be Treated When Coming from Out of Town?
Dr. Katz only treats Morton's neuroma of the foot.
No chronic pain cases, no heel pain, 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 personally performing over 2500 procedures.  As with any procedure, there is a chance that you will have no relief, get worse or have 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. 
The same rules appy if you require a second treatment at a later date.
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 such as traditional nerve removal

Important Notes:

• Dr. Katz does not take all people that desire to have cryosurgery, many factors will be considered.  He will make determinations on an individual basis.
• Success rates are decreased 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
• We understand that you will be making hotel and flight arrangements, however, we are not responsible for unforseen schedule changes within our office.  Of course, we will do our best to accomodate you.
• We are not responsible for delayed flights.  We recommend that you leave adequate time to make your scheduled appointment.

Please read all information below to be fully informed:

Cryosurgery: Be Informed About Your Procedure

1. Cryosurgery using the Cryostar is a safe minimally invasive procedure
2. Reduced risk of complications and higher success compared to the traditional procedures
3. Reduced recovery and healing time
4. Dr. Katz has performed around 2500 procedures over the past 6 years 

You should know that:

• 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:  Why didn't I get relief from the procedure? ANSWER:  With any procedure, there is no guarantee that you will get relief.  Dr. Katz has developed his procedure to give each patient the greatest chance of getting relief.  This is another treatment option that should be considered before more invasive procdures.  However, he makes it clear that this cannot be guaranteed.

 

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. 

QUESTION:  I've been to many doctors and have had virtually all treatments available.  I've read about cryosurgery and it sounds like a miracle! ANSWER:  Cryosurgery is a wonderful successful treatment for many painful foot and ankle conditions.  It is often superior to other treatments including the conventional surgeries.  However, no medical treatments can be miracles.  There are no medical treatments or procedures that work for all people.  So, please keep in mind that cryosurgery is a treatment that is not fail-proof.  You must approach the procedure with reasonable expectations.  Any physician claiming a guaranteed result, 100% of the time, is not being honest with you.

QUESTION:  How does your cryosurgery procedure differ from other cryosurgeons? ANSWER:  There is a very major difference.  Cryosurgery has been performed on the foot for over 5 years.  In its early days, there was no ultrasound guidance.  An incision was made and the probe was placed through the tiny incision to the area where there was the most pain.  The procedure was then performed in that area.  The results were decent at best and not very reproducible.  Most of the doctors that perform cryosurgery today perform it in this manner.  With better visualization so easily achieved with high powered color ultrasound, Dr. Katz prefers his method over the blind procedure and over the procedure that is done with a black and white ultrasound.  Dr. Katz calls his procedure CryoMax.   Dr. Katz has developed this technique and it has been refined with several of his colleagues and they are some of the only cryosurgeons performing this advanced procedure in the U.S.

 

CryoMax is a  much more precise procedure done with the aid of an ultrahigh resolution magnifying digital ultrasound capable of Doppler visualization of blood vessels.  The nerves are identified in close proximity to the vessels.  When CryoMax is performed, the Cryosurgeon is looking directly at the structures that he is freezing and can actually measure the area of nerve tissue that is frozen.  There is little doubt what is being frozen and whether the probe is in the correct area.  Without Doppler Ultrasound, the procedure is done blindly.  The percentage of success is much higher with color ultrasound guidance than without it. 

 

The general public needs to understand that because of the cost of proper training, equipment  and market pressures, many doctors perform the procedure blindly and have had little to no training.

 

To date, Dr. Katz is the only nerve cryosurgeon performing the CryoMax technique in the State of Florida and one of the few in the United States.   If you are going to have the procedure done, wouldn’t you prefer to have it done correctly to maximize the pain relief?

 

QUESTION:  Can I do both feet at the same time? 

ANSWER:  It depends on which areas are being treated and how many nerves are involved? Typically, Dr. Katz will treat  two nerves at a time or one heel at a time. 

  

QUESTION:  Will I have numbness in the foot that will affect my walking?   ANSWER: Some patients may have areas of numbness.  However, it depends on the area being treated.  Even if there is numbness, patients prefer that over pain.  The numbness would be a small area and does not cause walking problems.  The nerves being treated only provide sensation and have no control over the muscles or joints of the foot or ankle.

 

QUESTION:  Does my insurance pay for the procedure?  ANSWER:  Many insurances cover the procedure but some consider the procedure “experimental”! This is the insurance companies attempt not to pay for newer cutting edge technologies.  Also, Dr. Katz does not participate in certain insurance plans for various reasons.  His office will discuss cash payments with you.

 

 

 

QUESTION:  Why aren’t more podiatrists performing cryosurgery?  ANSWER:  Many podiatrists are not interested in new technology.  Dr. Katz prides himself on bringing the latest technology to his patients.  Cryosurgery also has a fairly large learning curve and the equipment to perform the CryoMax procedure is expensive.

 

 

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.  Even the possibility of CRPS/RSD can occur with any elective procedure.  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:  Can my problem that is treated with cryosurgery reoccur after the treatment? 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.

 

 

QUESTION:  Where is the procedure performed. 
ANSWER:  Cryosurgery is performed in the office using a local anesthetic.  There is no need to use a surgery center or hospital.  This is one way that the treatment is much more affordable than other treatments.


QUESTION:   Can this procedure permanently damage the nerve?
ANSWER:  In most cases, the nerve will regrow into a more functional normal nerve.  This is typically what the body will do.  However, it is possible to have permanent damage but this will usually have no adverse effects with respect to walking and activities.  You could have an area of numbness.

QUESTION: My insurance will not cover this procedure.   What is the cost of consultation?  Are there any other costs?  What is the total cost of cryosurgery?  ANSWER: You will need to call the office for details of costs.

QUESTION:   In the appointment before the cryosurgery treatment, how do you determine what is actually causing the pain, or should I say what do you use to diagnose the pain. ANSWER:  Dr. Katz has developed several specialized techniques for diagnosis.  He will spend adequate time with each patient to diagnose their unique problem.  Dr. Katz will use a power color ultrasound and small amounts of local anesthetic to locate the problem areas.   

 

QUESTION:  I was a patient for cryosurgery a few months ago. In general I am very pleased with the surgery. There were two neuromas present.  The “toggling” effect, which was very disturbing and debilitating  is gone.   And the “electrical shock” inside my foot is gone. Inside that same toe however there still seems to be a bit of a problem.  Do you think that it is something I should just accept or do you think you want to go in and do more freezing?  There is the electric shock effect and a burning along the bottom of that toe.  

ANSWER:  Glad to hear that you have had significant relief.  The pain in the toe is sometimes caused by a small nerve branch that goes into the toe.  I've had similar situation where I will go back in and freeze the area with success.  I typically advise waiting around 3-4 months from the first cryosurgery procedure before considering this type of repeat because it can resolve.

 

 

Question:  Will I need pain medication after the procedure?

ANSWER:  Most patients use over-the-counter medicine such as Tylenol or Advil.  However, rarely, we may use a mild pain medication. 

 

QUESTION:  Do I have to pay full price again if I need the procedure repeated? 

Answer:   You will need to call my office for these details.

 

QUESTION:  My insurance will not cover this since it is experimental? 

Answer:  Yes, this is common.  Insurance companies look for ways not pay for medical care.  This procedure has been in existence for about 25 years!  This is certainly not an experimental procedure.

 

QUESTION:  How many patients need to have cryosurgery a second time?  ANSWER:  We are unable to predict this possibility.  Each person’s body is different.  Some patients have had alcohol injections and other treatments that make the nerve more resistant to the freeze.  Some patients have even had the traditional surgery prior to having cryosurgery.  So, as you can see, we have to evaluate each person individually.   

 

 

QUESTION:  How soon after the procedure do you know it’s a success?  

ANSWER:   It could be immediate, several weeks or several months, again each person is different.  Your pain relief results from freezing of the nerve and nerve death.  Since we are all different the process can start quickly or may be prolonged.  This is the reason for such a large range of possibilities.

 

 

QUESTION:  Do you offer payment plans?   

ANSWER:   We do not offer payment plans for this procedure.  In order to keep the procedure at a reasonable cost we must be paid in full at the time of the procedure.

 

 

QUESTION:  What else is needed to make an appointment?   

Answer:   Speak with the office for help with all details.  Dr. Katz typically likes to see records from other doctors or a summary of your previous treatments. 

 

 

 

QUESTION:  Right after the cryosurgery, what are my limitations regarding walking, swimming, etc.?   ANSWER:   You will need to limit major activity for at least 48 hours.  However, some patients take longer to heal since each person is different.  Swimming is allowed when the small skin opening closes.  That will usually take 3-4 days.

 

QUESTION:  Would you be able to give me some references of patients who have had this procedure done?    ANSWER:   I am not able to do this because of strict privacy laws and time constraints.  Also cryosurgery is individualized for each patient.  Each patient has different pain and has had different treatments.  So, outcomes will be different for each patient.

 

 

 

QUESTION:   If I still have pain after the procedure, what are my options?  ANSWER:  Dr. Katz will possibly start you on an anti-inflammatory medication or other simple treatments.  You may require physical therapy. Typically, Dr. Katz will have you wait several months before evaluating success.  If you have had no relief or minimal relief the procedure can safely be repeated.  However, some patients need to consider the traditional nerve removal if cryosurgery is not a success. 

 

QUESTION:   Do you use ultrasound to find the nerve or neuroma?  When I’m not having the pain, it is hard to tell you exactly where it is.  ANSWER:   Dr. Katz uses ultrasound and has developed a method of using a diagnostic injection to locate the proper nerve.  He is one of the few podiatrists in the U.S. using power color doppler.  Dr. Katz has developed  his own specialized techniques using the Doppler

 

 

QUESTION:  If I have the cryosurgery, do you think I will be able to return to my regular exercise?   ANSWER:   Most patients return to normal activity and that is the goal, however there is no way to predict who may or may not be able to return to all activities.  There are so many variables involved.  Those patients that do strenuous exercise or marathons will likely require extra time for healing.

 

QUESTION:   What are the risks associated with cryosurgery?   ANSWER:   They are the same as any surgery but since the procedure is minimally invasive, complications are rare.  Infection, abscess and worsening of pain are a few possibilities.  However, again these would be extremely rare.  You will be able to discuss this with Dr. Katz in detail.

 

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:   How many have been pain free after the cryosurgery and for how many was the surgery unsuccessful or the pain got worse?  ANSWER:  I do not keep exact numbers but I have done over 2500 cryosurgery procedures over the past years.  There is no accurate way to calculate a percentage success rate.  It is rare not have some relief and even more rare that the problem would worsen.

We frequently get referrals from patients that have had the procedure and have had continued relief.

I can tell you that this procedure is far superior to having the nerve removed and there is no chance of stump neuroma (a complication of nerve removal).  It would be extremely rare to get worse.   So this is likely your best option.  It would not be unusual to be pain-free for years.

 

 

QUESTION:   Are you aware of anyone in my city who is experienced with cryosurgery?  ANSWER:  I can  only recommend other cryosurgeons that I personally know.

 

 

 

QUESTION:   Will the procedure hurt? 

ANSWER:   Dr. Katz will use local anesthetic to numb your foot.  This will be the only part that may cause discomfort.  Since Dr. Katz has developed an advanced technique using the color power Doppler, he is able to locate the freezing spot.  This avoids the need for the use of techniques that are more painful.  Dr. Katz developed this technique to allow his patients to have cryosurgery with minimal discomfort.  This is a newer way to have cryosurgery.

 

 

QUESTION:   Where do you perform the procedure?   ANSWER:  The procedure is done in the office and takes 30 minutes or less.  This allows the cost of the procedure to be significantly lower and affordable when compared to procedures done in surgery centers.  This is one important benefit of cryosurgery.