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A prospective study testing the efficacy of cryosurgery on painful plantar fasciitis of the heel was performed. Cryosurgery, a minimally invasive, percutaneous, office-based technique, was used to treat 59 consecutive patients (61 heels), who had failed prior conservative therapy and were considered surgical candidates. Patients were evaluated on an 11-point visual analog scale administered preoperatively and up to 1 year of follow-up. The mean pain rating (8.38) before cryosurgery (day 0) is statistically significant to the mean pain rating (1.26) at day 365 postoperatively. Pain decreased significantly after the procedure (analysis of variance, P < .0001). These results suggest cryosurgery is significantly effective in treating patients with recalcitrant plantar fasciitis. Cryosurgery offers a highly effective treatment modality after failed conservative treatment without resorting to open invasive outpatient surgery.
Am I missing the point or something?
What about a control group? What about the validity of the outcome measure? What about the natural history of the disease process?
The latest Podiatry Today has the full text of this article: Case Studies In Cryosurgery For Heel Pain
Quote:
Can cryosurgery offer a less invasive option for patients who fail conservative therapy and other modalities for heel pain? This author, who has performed over 600 cryosurgery procedures, offers insights on the advantages of this procedure and shares four intriguing case studies as well.
The Wall Street Journal are reporting: Quick-Freeze Procedure To Heal a Heel in Pain
Quote:
...Cryosurgery is a simple office procedure in which a tiny probe is inserted in the heel under local anesthetic. It's brought to a freezing temperature, which destroys nerve fibers -- giving relief from pain, says Taylor, Mich., podiatrist Lawrence M. Fallat, who pioneered cryosurgery for plantar fascitis about seven years ago. The nerves regenerate in about six months, Dr. Fallat says, but the pain remains at bay. It isn't known why, but he believes it is because the previously irritated and swollen nerves become normal when they regenerate after the freeze. .....
...In a study of 59 plantar fascitis sufferers published last year in the Journal of Foot and Ankle Surgery, Dr. Fallat and his associates found pain decreased on average from 8.38 on a scale of 10 to 1.26 a year after cryosurgery.
Another podiatrist, Javier Cavazos of McAllen, Texas, reports in an abstract accepted for presentation at the APMA's July annual meeting that 76% of 168 subjects who had cryosurgery had little or no pain two years later, while 24% had at least a little bit of pain. Overall, pain was reduced from an average of 7.57 on the scale of 10 to 1.10.
However, neither study had a control group, drawing skepticism from some physicians since heel pain can resolve on its own.
"I don't think it works," says George Theodore, co-director of the Foot and Ankle Surgery Service at Massachusetts General Hospital and team physician for the Boston Red Sox. "There is no randomized double-blind, placebo-controlled study out there. Most of what we hear is anecdotal."...
BACKGROUND: Although cryosurgery has been used to treat certain conditions, its efficacy for the treatment of heel pain has not been established. The objective of this retrospective case series was to investigate both short- and long-term changes in heel pain after cryosurgery.
MATERIALS AND METHODS: A sample of 137 feet (n = 137) was analyzed over a 24-month period after cryosurgery. The mean age was 56 years and the mean BMI was 33. Subjects in our analysis included only those who had failed 6 months of conservative care prior to cryosurgery. Pain was measured using a Numeric Pain Scale (NPS, zero to 10) at 3 weeks and 24 months. Statistics were calculated using SPSS version 12.0 (Chicago, IL).
RESULTS: A total of 106 subjects had successful pain relief and 31 subjects failed to gain relief; the success and failure rates were 77.4% and 22.6%, respectively. Mean pain before cryosurgery was 7.6, after cryosurgery at three weeks was 1.6 (p < 0.0005), and after cryosurgery at 24 months was 1.1 (p < 0.0005).
CONCLUSION: In subjects who achieved successful pain relief, the significantly lower mean pain score at 3 weeks and 24 months, compared to the initial pain score prior to cryosurgery, suggests that cryosurgery was successful in resolving both short- and long-term heel pain
BACKGROUND: Although cryosurgery has been used to treat certain conditions, its efficacy for the treatment of heel pain has not been established. The objective of this retrospective case series was to investigate both short- and long-term changes in heel pain after cryosurgery.
MATERIALS AND METHODS: A sample of 137 feet (n = 137) was analyzed over a 24-month period after cryosurgery. The mean age was 56 years and the mean BMI was 33. Subjects in our analysis included only those who had failed 6 months of conservative care prior to cryosurgery. Pain was measured using a Numeric Pain Scale (NPS, zero to 10) at 3 weeks and 24 months. Statistics were calculated using SPSS version 12.0 (Chicago, IL). RESULTS: A total of 106 subjects had successful pain relief and 31 subjects failed to gain relief; the success and failure rates were 77.4% and 22.6%, respectively. Mean pain before cryosurgery was 7.6, after cryosurgery at three weeks was 1.6 (p < 0.0005), and after cryosurgery at 24 months was 1.1 (p < 0.0005).
CONCLUSION: In subjects who achieved successful pain relief, the significantly lower mean pain score at 3 weeks and 24 months, compared to the initial pain score prior to cryosurgery, suggests that cryosurgery was successful in resolving both short- and long-term heel pain.
Am I missing the point or something?
What about a control group? What about the validity of the outcome measure? What about the natural history of the disease process?
How can these studies continue to make the claims that
Quote:
suggests that cryosurgery was successful in resolving both short- and long-term heel pain.
when they are not using a control group!. Did not Karl Landorf's study on plantar fasciitis show that his placebo group got better at 12 months!
Last edited by Admin : 25th July 2009 at 04:05 PM.
Reason: added link to karl's study
Cryosurgery and plantar fasciitis
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