A Case Report of Cryoneurolysis for Dorsal Foot Pain and Toe Clawing in a Patient With Multiple Sclerosis.
Fraser MacRae, Abby Speirs, Andrei Bursuc and 2 others
PMID 37744197WHAT IT FOUND
In one patient with MS, cryoneurolysis of the FDL motor branch and superficial fibular nerve relieved dorsal foot pain and toe clawing for five and a half months.
Symptoms returned, requiring retreatment. This is a single case, not proof the treatment works for others.
Key findings
01Bilateral cryoneurolysis provided immediate pain relief and improved gait by reducing toe clawing.
02The benefits lasted for five and a half months before symptoms returned and retreatment was requested.
03The patient reported no adverse events and tolerated the procedure well, aside from mild bruising and burning.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This is a single case report, so the results cannot be generalized to other patients with MS. There are no validated objective measures for dystonic toe clawing, so the outcome relies on patient report. The patient was already using botulinum toxin and multiple medications for pain, which may have influenced the overall clinical picture, though the paper states no change in foot pain from BoNT. The effect was not permanent, requiring retreatment after five and a half months.
Declared interests
The paper does not explicitly state funding sources or conflicts of interest in the provided text, but it mentions the use of the Iovera Handheld System by Pacira Biosciences.
The easy way to misread this
Do not interpret this single patient's positive outcome as evidence that cryoneurolysis is a proven or widely effective treatment for toe clawing or neuropathic pain in MS. The relief was temporary, lasting only five and a half months, and the lack of objective measures means the findings are based solely on one person's subjective report.