Radiofrequency FAQ

Whilst most drugs can safely be continued during radiofrequency, there are a few that can interfere with the procedure. You should only change your medication after first discussing this with your GP or the specialist who has prescribed them. Below is a list of the medications that could aid healing. Please contact our Centre if you require further information: Aspirin This medication may cause some increased bleeding during cryosurgery, although the risk is fairly small and generally patients can continue with aspirin if they wish to. However, if you are taking aspirin without a serious medical reason, we would suggest that you abstain for a week before the procedure. Clopidogrel This is an antiplatelet drug that is often prescribed for heart and other vascular conditions. We do not recommend taking this drug during ablative radiofrequency – you should stop 10 days before the procedure. We would strongly advise that you discuss this with your cardiologist or GP first. Warfarin It is not considered safe to have radiofrequency for Morton’s neuroma whilst on Warfarin, particularly if you are taking an amount that causes your INR to rise above a level of 2. Generally speaking, for ablative radiofrequency we would wish your INR to be below 1.5. Patients on Warfarin may need to convert to low molecular weight heparin a few days before their operation to reduce the risk of adverse bleeding. We are happy to liaise with your GP or haematologist to facilitate this, and an expert opinion from these individuals may be required before your procedure can take place. Methotrexate This drug is often given to manage rheumatoid arthritis or other forms of inflammatory arthritis. Opinions vary between rheumatologists, and some are quite happy for cryosurgery to take place without adjusting your Methotrexate dose. However, we would always recommend that you discuss this with your Consultant Rheumatologist first. Methotrexate belongs to a group of drugs called DMARDs (disease-modifying antirheumatic drugs). There are others in this group, and we would give specific advice if you require further information. Rivaroxaban This is a relatively new type of blood thinning drug that has to be stopped two days before cryosurgery can safely take place.

Ablative radiofrequency, as performed at our Centre, involves burning the nerve by means of a needle with a heated tip. By destroying the nerve through heat, it can no longer transmit pain. The procedure differs from cryosurgery in a number of ways. A key difference is that patients who undergo cryosurgery generally do not lose sensation from a small section of their toes, whereas this is likely with radiofrequency. The procedure is minimally invasive and highly specific to the neuroma, with minimal damage to adjacent tissues.

The procedure itself is generally not painful as it is carried out under a local anaesthetic. This anaesthetic is usually injected into the ankle and top of the foot, not at the site of the neuroma. Here, the skin is relatively soft, and the injection is generally not too uncomfortable. After the procedure, we have found that patients can experience mild discomfort, which is slightly more significant when compared to cryosurgery.

Patients tolerate the injection well, and this is reflected by other studies. Barrington et al. (2014) explored patient willingness to undergo a repeat peripheral nerve block in the event of any further surgery that they may require. The study reviewed 9,969 surgical procedures with a response rate of 61.6 per cent. 94.6 per cent of patients were willing to have a repeat nerve block if required. At our Centre, the vast majority of patients cope very well with the injection and describe only mild to moderate discomfort.

Your entire appointment will be one hour. This includes the time it takes for your foot to go numb following the administration of local anaesthetic.

We recommend that you travel home on the back seat of a car so you can keep your foot elevated. You should rest for 24 hours but can then return to work. You should avoid longer periods of walking (short walks of 10 minutes or so should be fine).

It is very important that patients keep their foot and dressing dry for the three days. The patient can then remove the dressing after this time. Generally, the small incision will have completely closed. However, if there is still an open wound, a dressing should be re-applied, and patients should contact us for further advice.

We generally recommend that you wait two to three months, but this does vary from patient to patient. It also depends on the type of sport – patients should discuss this directly with the Centre for specific advice.

You should give the procedure three months to work. However, the response to treatment does vary from patient to patient. The most important thing is to 'listen to your body' and to do as much or as little according to your comfort levels. If you have little to no pain after two to three weeks, then you will clearly be able to do more than if your foot still has some tenderness.

Some patients bleed and bruise a little more than others. Pain thresholds also vary from patient to patient, and some may be more sensitive to the procedure.

The incidence of complication is small. We not yet performed as many ablative radiofrequency procedures as cryosurgeries, but the numbers are increasing. To date we have not encountered any significant complications.

No. The procedure has been used for many years, especially in the management of back pain. There are many medical papers on ablative radiofrequency, although more so on back pain. There are an increasing number of studies on the technique for Morton's neuroma. Mr McCulloch has submitted work for NICE and the procedure has been reviewed by this organisation.

Patients who have failed open surgery may respond to ablative radiofrequency by cauterising the distal hypersensitive part of the remaining nerve. This may be imbedded in scar tissue or present as a stump neuroma. We would only recommend this if cryosurgery has not been effective.

Patients who have failed open surgery may respond to ablative radiofrequency by cauterising the distal hypersensitive part of the remaining nerve. This may be imbedded in scar tissue or present as a stump neuroma. We would only recommend this if cryosurgery has not been effective.

In most cases yes, but please call the Centre for further information before contacting your insurance company.

Yes, but patients may not notice this as it only affects a small section at the underside of the webbing of two adjacent toes.

This depends on your specific circumstances, but often we prefer to treat a single neuroma. We can perform diagnostic injections to identify whether more than one neuroma requires treatment. We prefer not to treat two feet at the same time as this can slow down recovery.

Yes, the probe that is used will cauterise the wall of the bursa as well as the neuroma, if this is planned.

Because the nerve is destroyed through heat, the procedure is likely to be permanent, although recurrence is possible.

We are carefully auditing the results of ablative radiofrequency in accordance with NICE (National Institute for Health and Care Excellence) guidelines. NICE has no major safety concerns on the procedure. The following information is taken directly from NICE’s guidance on Radiofrequency ablation for symptomatic interdigital (Morton’s) neuroma: Current evidence on radiofrequency ablation for symptomatic interdigital (Morton's) neuroma raises no major safety concerns. The evidence on efficacy is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research. Clinicians wishing to do radiofrequency ablation for symptomatic Morton's neuroma should: Inform the clinical governance leads in their NHS trusts. Ensure that patients understand the uncertainty about the procedure's efficacy and provide them with clear written information. In addition, the use of NICE's information for the public is recommended. Audit and review clinical outcomes of all patients having radiofrequency ablation for symptomatic Morton's neuroma (see section 6.2). NICE encourages further research into radiofrequency ablation for symptomatic Morton's neuroma. Further research should include details of patient selection and previous treatments. Studies should compare the procedure against other non‑surgical treatments, such as steroid injections. Outcome measures should include pain relief, the duration of treatment effect, and the need for subsequent treatments.

It is true that the procedure is more established in the United States than in the UK. The equipment costs are high and, like cryosurgery, mastering the procedure requires a significant level of investment in time and training. An expert knowledge in ultrasound and minimally invasive surgery is also required. Mr McCulloch, the primary Consultant Podiatric Surgeon, has a master's degree in diagnostic ultrasound. He is a senior lecturer on the subject and has many years of experience in performing minimally-invasive medical procedures of the foot and ankle.

No. We would recommend that the procedure is performed by a Consultant Podiatric Surgeon. This is your guarantee that your podiatrist is highly qualified and capable of managing all aspects of your problem.

No. We offer the full range of procedures including cryosurgery and open surgery. We will fully consider all treatment options.

We usually recommend cryosurgery before radiofrequency, although each case is of course unique. Whilst it is often noted in medical literature (J. Jerosch et al. 2006) that open surgery has a reasonable success rate of about 75 per cent, Womack and Richardson (2008) published data in direct contradiction to these success rates. In their series of 120 patients who underwent resection for Morton's neuroma, 50 per cent had a good or excellent result, 10 per cent had a fair result, and 40 per cent had a poor outcome. One of the reasons for leaving open surgery as a last-resort option lies in the 25-35 per cent risk of developing post-surgical pain and an unsatisfactory outcome.

Please contact us for further information regarding costs.