Common Questions

	Frequently Asked Questions

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.

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: 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: Is it possible that I will travel from out of town and I will not be a candidate for cryosurgery? ANSWER: Yes that is possible. Some patients come in with complex problems that may not benefit from cryosurgery or an incorrect diagnosis from another doctor. So before traveling to Tampa, please realize that possibility.

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. 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.

QUESTION: Can my problem that is treated with cryosurgery reoccur after the treatment?
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.

QUESTION: I am coming from out of town. Realistically, how quick can I travel home.
ANSWER:  Most people go home the next day.

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:   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: I have arthritis, does this affect the likelihood of success of the cryosurgery?   ANSWER: No, we use cryosurgery to treat people for pain associated with arthritis

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:   If I choose to do this, I will try to combine it with a vacation, since I don’t live in Tampa. Would I need to be off my feet afterwards? ANSWER:   You would need to take it easy for 2-3 days, that's the average, some more and some less. We don’t recommend going to Disney, etc. and walking around excessively.

QUESTION:   I am coming from out of town. I am wondering if I can know before I return home if the procedure worked.   ANSWER:   Not necessarily. You may be sore from the procedure and it would be hard to tell until healing and death of the nerve are complete.

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: 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. 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.

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.

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 1000 cryosurgery procedures over the past 2-3 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.