Healing Plantar Fasciitis with Cryoablation

The plantar fascia is a wide ligament-like structure that covers the bottom of the foot, extending from the heel bone to the base of the toes. This band of thick tissue protects the bottom of the heel bone and acts like a shock absorber for the bottom of the foot.

In many people, the plantar fascia may become irritated, causing a condition called plantar fasciitis. This is the most common cause of heel pain. The cause of this condition is not entirely clear, but is associated with or due to repetitive trauma. It is common in several sub-groups of people, including runners and other athletes, people who have jobs that require a fair amount of walking or standing (especially if it is done on a hard surface), and in some cases it is seen in people who have put on weight, including through pregnancy. One disturbing fact about plantar fasciitis is that it sometimes takes many months to resolve. Seventy-five percent of all patients may not recover until approximately six months and then only 98% may recover by 12 months.

Description of Plantar Fibroma

Plantar fibromas are relatively uncommon, benign but locally invasive lesions that are characterized by fibrous proliferation arising from the plantar fascia. On clinical examination, fibrous nodules in the plantar arch with frequent bilateral involvement characterize plantar fibroma. Typically, these nodules are painless or cause only vague or perhaps moderate pain. Fascial scarring and contracture may be seen late in the disease course. Radiographic findings are usually normal. Diagnosis is made with palpation of plantar nodules. Treatment is initially conservative, but surgery may be indicated in patients with painful or deep infiltrating lesions. The high incidence of recurrence after surgical excision and the potential for problematic wound healing and scarring presents a significant challenge in the management of this condition.

Description of Cryoablation

Cryoablation has been proposed as an alternative treatment for patients who have failed prior attempts of conservative therapies for plantar fasciitis and plantar fibroma. Cryoablation is described as a minimally invasive outpatient procedure typically performed on the proximal plantar area of the foot. After administration of a local anesthetic, a small incision is made adjacent to the area of primary discomfort. A specialized probe is inserted into the area of “trigger point” type pain and the area is then treated with a series of cooling then thawing cold applications. The resultant 6- to 8-mm “ice ball” formed at the cyroprobe tip will destroy nerve tissue by causing extensive vascular damage to the endoneural capillaries or blood vessels supplying the nerves. Freezing the particular areas of pain caused by plantar fasciitis creates a block that stops the conduction of pain. No sutures are necessary and a small dressing is applied to the surgical area. There is minimal need for post-operative pain medication and most patients promptly resume normal activities.