Neuroma Cryoablation

Background and indications

A neuroma is a nerve thickening, most commonly Morton's neuroma (plantar interdigital nerve in the forefoot), but also post-surgical or post-traumatic stump neuromas. Morton's neuroma affects approximately 30% of adults, with female predominance, causing burning metatarsal pain, electric shock sensations, and toe numbness.

Percutaneous cryoablation is a minimally invasive alternative to surgical neurectomy, offered after failure of conservative treatments (orthotic insoles, corticosteroid injections, appropriate footwear) for at least 3-6 months.

Pre-procedure assessment

Assessment includes foot ultrasound or MRI confirming the neuroma and its location (typically in the 2nd or 3rd intermetatarsal space), and clinical confirmation (positive Mulder's sign). Neuroma size is measured (generally > 5 mm to indicate treatment).

Procedure

Under local anesthesia, a fine cryoprobe (17G) is inserted into the neuroma under ultrasound guidance. Gas (argon or CO2) is activated, creating an ice ball encompassing the neuroma. Two freeze-thaw cycles of 3 to 5 minutes are performed. The ice ball is visible on ultrasound, allowing real-time monitoring. The procedure takes approximately 20 to 30 minutes.

Results and scientific evidence

A study of 20 patients with Morton's neuroma treated by percutaneous cryoablation showed an 85% clinical success rate with significant pain reduction at 6 months (Friedman et al., Radiology, 2012; DOI: 10.1148/radiol.12120446). Mean VAS pain score decreased from 7.1 to 2.3.

More recent series confirm satisfaction rates of 75-85% at 12 months. If results are insufficient, a second session can be offered. The main advantage over surgery is the absence of plantar scar (a frequent source of postoperative pain) and preservation of sensation.

Risks and complications

Complications are rare and minor: local bruising (common, benign), temporary numbness of adjacent toes (10-15%, resolving within weeks), transient local pain. Major complications (vascular injury, infection) are exceptional.

Recovery

Walking is possible immediately with comfortable shoes. Full weight bearing is permitted. Pain improvement is progressive over 2 to 6 weeks. Follow-up is scheduled at 1 and 3 months.

Practical information

The procedure is performed on an outpatient basis. It is performed by an interventional radiologist.