I’m warming to cryosurgery to f ix my foot

Q I HAVE suffered with debilitating Morton’s neuroma in my right foot for about four years. I’ve tried everything from different shoes and heels to insoles, acupuncture, podiatry advice, taping up my foot and injections. There is a new private treatment called cryosurgery and I was wondering if there’s any evidence that it works.

A MORTON’S neuroma is a very painful and incapacitating condition that affects one of the nerves running between the toes. It is thought to be shoe-related, as it tends to happen to women over 40 with a history of wearing high-heeled, pointed shoes. Pain shoots down into the toes and the foot is very tender over the neuroma. Typically, pain occurs only while wearing shoes.

Treatment may involve shoes, insoles, pads and pain relief. The insole must be fitted by an orthotics team and is known as a metatarsal dome orthotic. Injections are a common type of treatment.

About a third of sufferers will not benefit from such treatments and are left to consider surgery. This can involve different procedures – the offending nerve may be removed, or it can be decompressed by removing the ligaments from around it. As with any surgery, there are risks, and there is no guarantee the problem will be solved. Some patients are left with numbness of the toes.

Cryosurgery is a newer treatment using very low temperatures to destroy the nerve causing the pain. Many private centres now offer it as an option before trying more substantial surgery, as it is far less invasive. Theoretically this would therefore involve a faster recovery and fewer complications. As it’s a newer treatment, there is not a huge body of evidence behind it. But results from centres in the UK are good, so it would be worth considering.

Q MY HUSBAND has chronic pancreatitis. He is teetotal, so it’s not drink-related. His consultant says there is no cure and that little or no research is being done into the condition. Do you know what can be done?

A IT IS a very hard situation to be told not only that you have a chronic illness, but that little can be done about it.

Alcohol is indeed the most common cause of chronic pancreatitis, but actually about 30 per cent of sufferers are not heavy drinkers. In other words, pancreatitis can be an auto-immune condition where the body has developed antibodies to itself, and this may be found in individuals with other auto-immune conditions such as arthritis.

The main role of the pancreas is in digestion. It produces enzymes to break down food, as well as producing insulin to control sugar.

In pancreatitis, when the pancreas is inflamed, these functions are compromised, leading to poor absorption of food and diabetes. Patients suffer pain, weight loss, nausea and loose stools.

A review of the National Institute for Health and Care Excellence treatment guidelines for chronic pancreatitis sadly confirms that there is little on offer for the condition. Lifestyle recommendations include avoiding alcohol and smoking. Good pain treatment is vital: this should be trialled in a step-wise fashion, looking first of all at simple painkillers such as ibuprofen and codeine before adding more substantial prescription drugs like amitriptyline or gabapentin.

Consultants can offer treatments relating to pain relief rather than curing the condition itself. These may involve endoscopic procedures or even surgery. A dietician should be able to provide advice on the low-fat, high-protein and high-calorie diet that is needed with supplements for the fat-soluble vitamins that can be lost. It can also be vital to replace the pancreatic digestive enzymes with a tablet called creon, which can help both pain and the symptoms of poor food digestion.