Cryosurgery (also called cryoablation, cryotherapy or simply cryo)

Cryosurgery is occasionally used to treat Ledderhose disease (Morbus Ledderhose). A probe is inserted into the diseased tissue and the nodule and the surrounding tissue is deeply frozen, typically with liquid Nitrogen, more recently also with thinner probes using Argon or other gases. Cryosurgery "will destroy nerve tissue by causing extensive vascular damage to the endoneural capillaries or blood vessels supplying the nerves" (anthem.com) and thus kills the nerves' ends in this area. The purpose is to reduce pain and shrink the nodules.

Literature documents only a single case where a Ledderhose patient was treated with cryotherapy. In that case the treatment was successful and the nodules reduced in size. We are here reporting three more recent and successful treatments of Ledderhose disease, including pictures that one of the patients (David Adams) shared with us cryotherapy details. Another case is presented by Dr. Steven Goldstein on  http://www.cryosvs.com/Cryotech-PlantarFibroma.pdf. Another personal experience with cryo for Ledderhose is Bashkar's story.

At the Dupuytren conference in Miami 2010, results for cryotherapy of Ledderhose were presented by Terry Spilken (presentation on youtube). They have been published in more detail as chapter "Cryotherapy and other therapeutical options for plantar fibromatosis" in Ch. Eaton et al. (Eds.) "Dupuytren's Disease and Related Hyperproliferative Disorders" (Springer, New York, 2012), p 401-408, available in printed form and as ebook cryo_chapter.

Cryosurgery can reduce the size of Ledderhose nodules but they probably will come back. Those who plan having cryosurgery might consider the advice of a patient (David) who already had several cryos for Ledderhose: "The doctor treated nodules by moving the probe under the skin to treat nodules as much as 3 inches away. That was a big mistake. If you are going to have cryo, always have them go straight down into each nodule. Almost no bruising if they do this. More wounds, but they are small and don't even scar." We also want to mention that some patients find the procedure itself painful and if their Ledderhose was very painful before, cryosurgery might not relieve their pain. But others are reporting that the shrinking of the nodule reduced problems and alleviated walking.

Cryosurgery is not always successful in reducing pain. If the nodules are already causing considerable pain before treatment, they are probably close to a nerve and crysurgery might cause nerve damage, as mentioned above. Some patients treated with cryosurgery were not satisfied and reported that they do not recommend this treatment.

For further information on cryotherapy you might e.g. have a look at cryotherapy_overall or at the cryotech web site. Because we are not yet aware of studies with good statistics regarding cryotherapy of Ledderhose, and we have little indication of side effects and no long term results except the general ones of cryotherapy, we consider this therapy for Ledderhose as still somewhat experimental, although cryotherapy itself has been in use for many years.

For Dupuytren's contracture we doubt whether fingers can be released with cryosurgery and we would be concerned about nerve damage in the hand or the damage of arteria, which might result in the loss of fingers.

Cryosurgery or rather the according devices have been approved by the FDA to be sold within the USA for a variety of applications, like e.g. treatment of skin fibroma (see e.g. FDA_cryo_devices). Cryosurgery has not been specifically approved by the FDA for the treatment of Ledderhose disease but this might or might not fall in the category of approved pain relief (Dupuytren Society can't judge that).

Don't confuse cryo surgery, which is using a probe to guide the liquid nitrogen to the diseased tissue, with spraying liquid nitrogen onto the skin (like for treatment of warts). One patient reported this application to Ledderhose but we haven't seen any longer term results. We doubt whether this technique works, but if it does it is probably restricted to small nodules that are located directly under the skin. We would also be concerned about skin damage.

Clinics doing cryosurgery of Ledderhose:

It seems that only a few clinics in the USA have experience with cryosurgery of Ledderhose. The scenario is changing, some have stopped doing it, other are picking up and interested patients will probably need to find out themselves where they can receive treatment. In Europe we are aware of only a single clinic, in the UK, barn_clinic, thanks to the Ledderhose blogspot.

 

 

Page last modified: 01/11/2017