Abstract
A Novel Approach to Post-Traumatic Foot and Ankle Pains using Percutaneous Ultrasound Guided Cryoneurolysis: A Case Report
Highlights
Cryoneurolysis is a minimally invasive, low side effect profile, evidence-supported intervention currently with FDA approval to produce lesions in peripheral nervous tissue, including for relief of pain associated with knee osteoarthritis [1]
Current osteoarthritis treatment supports efficacy when used along the infrapatellar branches of the saphenous nerve for medial knee pain and anterior femoral cutaneous nerve for superior knee pain [1]
Perineurium and epineurium remain intact, myelinated axons regenerate at a rate of 1.01.5 mm per day
Summary
Cryoneurolysis is a minimally invasive, low side effect profile, evidence-supported intervention currently with FDA approval to produce lesions in peripheral nervous tissue, including for relief of pain associated with knee osteoarthritis [1]. In a sample of 23 patients who had an isolated ankle arthrodesis for painful post-traumatic arthritis of the ankle and were followed for 12 to 44 years following surgery, the majority had “substantial, and accelerated, arthritic changes” in the operative foot [6]. In these patients, WOMAC, Foot Function Index, and Short Form-36 scores have demonstrated that foot pain limits physical function [6]. While arthrodesis remains the standard of care for end-stage foot and ankle osteoarthritis, there are several drawbacks, namely: chronic post-operative pain, adjacent joint arthritis, and functional limitations [5]. Given the patient’s lack of successful response to conventional management, we considered intervening with ultrasound-guided cryoneurolysis
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