Preparation
Important things to remember when you attend your first appointment
Shoes
Always bring the shoes that most aggravate your pain. This is very important, as the clinic sometimes carries out diagnostic injections – these are only helpful if you have shoes that rapidly bring on your symptoms.
Insoles and Pads
Always bring insoles and pads that have been made or bought to treat your neuroma. We will not perform cryosurgery on a patient who has not tried some form of conservative care such as insoles, pads or footwear change.
Scans or Medical Reports
Always bring your scans or medical reports if you have these, especially if you hope to have treatment on the day of your consultation. Ideally send them to us before you attend.
Driving
Do not drive to the centre for your initial appointment. You may require a diagnostic injection, in which case you will not be able to safely drive home. However, you can usually drive if your left foot is affected and you have an automatic car. Please note that after cryosurgery patients must rest on the back seat of the car with their foot elevated, and they cannot drive or use public transport.
Before Your Appointment
We will send you a comprehensive surgery information pack. This contains our foot surgery information booklet, which provides information on podiatric surgery, including training and qualifications. It is important that you read this as it also covers the possible risks associated with surgery.
Before your appointment, we will ask you to sign and send us a form, which confirms that you have read the relevant information leaflets about ablative radiofrequency treatment. Where possible, we prefer not to treat patients on the day of their consultation. We do appreciate, however, that some patients have a long way to travel.
Whether we proceed with an operation is entirely up to the discretion of Mr McCulloch. Key factors that would steer this decision include:
a.
Confirmation that your symptoms are indeed consistent with an interdigital neuroma. If you are travelling far, then it is obviously in your interest to make sure you have the correct diagnosis. Ideally you should have an MRI or ultrasound scan report from a consultant radiologist. In some instances, Mr McCulloch may not agree with the diagnosis that you have been given by another practitioner. Sometimes more than one neuroma may be present, in which case a diagnostic injection can help with the diagnosis. We can often do this during the consultation, and in some instances a positive response may then allow for radiofrequency treatment to take place. In some cases, patients have more than one condition, where foot instability has led to neuroma symptoms alongside other pathologies. In these cases radiofrequency may not be the best treatment option, or if performed we will carefully counsel the patient on the fact that some symptoms from other causes may remain.
b.
Confirmation that conservative care has been tried. All patients must have tried conservative care for a reasonable period – this largely consists of insoles, orthoses and footwear change. We will not necessarily expect you to have tried a steroid injection.
c.
Patients with a more complex medical history may require more extensive medical preparation prior to radiofrequency treatment. If they are under another consultant, such as a neurologist, rheumatologist or pain specialist, Mr McCulloch will often wish to liaise with these specialists before proceeding with ablative radiofrequency. However, we will often treat higher-risk patients, as they may be far more suited to minimally-invasive radiofrequency than open surgery.