Should I consider cryosurgery or ablative radiofrequency for my Morton’s neuroma?
This is a question that is often asked at our Centre. On balance in the vast majority of cases we would recommend cryosurgery before considering ablative radiofrequency. Cryosurgery is a process where the surgical procedure involves freezing the neuroma, where ablative radiofrequency involves burning the neuroma.
We tend to recommend ablative radiofrequency for patients who have failed to respond to cryosurgery. Currently our success rate with cryosurgery is over 70%. Ablative radiofrequency has a similar success rate when undertaken on patients who have failed to respond to cryosurgery. This would suggest that in some instances, ablative radiofrequency may be more affective than cryosurgery. The reasons why cryosurgery is recommended prior to ablative radiofrequency are as follows:
1) Ablative radiofrequency is associated with some increased post-treatment pain when compared to cryosurgery.
2) Cryosurgery often allows for recovery of the nerve and therefore there is no loss of sensation. Ablative radiofrequency because of its more destructive effect on the nerve may cause some permanent numbness in the area of surgery which may be irreversible.
3) Our Centre has performed over 1000 cryosurgery procedures, and to date there have been no significant long-term complications from this procedure. We have performed a good number of ablative radiofrequency procedures, but more numbers are required before we can make a direct comparison to cryosurgery. Cryosurgery remains an extremely safe procedure and therefore we recommend it prior to considering the ablative radiofrequency procedure.
4) We have found that a percentage of patients who have had the ablative radiofrequency require a post treatment steroid injection to settle inflammation from the procedure, something that is far less frequently required for cryosurgery.
In conclusion we recommend cryosurgery as a first line treatment for Morton’s neuroma and in the 30% of patients who do not respond to this treatment, there is the option of considering ablative radiofrequency. These procedures in most cases help to mitigate the need for neurectomy (excision of the nerve) which most patients who come to the Centre want to avoid.