Open technique is more effective than percutaneous technique for TOPAZ radiofrequency coblation for plantar fasciitis
Introduction
Plantar fasciitis is a common problem, afflicting a significant proportion of the population at some point in their life. It is said to be the most common cause of heel pain, and various epidemiological studies place its prevalence at 10% in the general population and up to 22% in runners [1], [2], [3].
The disease has been shown by Lemont et al., more accurately, to be a ‘fasciosis’, similar to tendinosis. There is a characteristic lack of inflammatory cells, an abundance of disorganised collagen and fibroblastic hypertrophy, as well as disorganised vascular hyperplasia with avascular tendon fascicles [4]. The result is reduced nutritional flow to the affected tendon, with compromised repair and re-modelling of extracellular matrix required for healing.
Most cases resolve with conservative therapy, including rest, analgesia, physiotherapy, orthotics and steroid injections [5], [6]. For recalcitrant cases, extracorporeal shockwave therapy provides varying degrees of success [7], [8], [9], [10]. On the other hand, the traditional surgical release of the plantar fascia yields a better success rate, but is known to have a number of undesirable effects, namely prolonged surgical recovery time, patient apprehension, and various surgical complications including arch instability, plantar fascia rupture and excessive strains in surrounding structures [11], [12], [13].
More recently, radiofrequency microtenotomy, by stimulation of an angiogenic healing response in tendons, has been successfully used to treat tennis elbow and rotator cuff tendinosis [14], [15], [32]. Plantar fasciitis has been shown to respond to this treatment as well [33], [34]. The results of our previous pilot study were also encouraging, when using this method to treat plantar fasciitis [16]. Furthermore, Weil et al. have shown that this technique can be administered using a minimally invasive approach [17]. The long-term outcome of this modality has yet to be studied.
The purpose of this study is to directly compare the open and the percutaneous (minimally invasive) approach of radiofrequency microtenotomy in the treatment of plantar fasciitis, as well as assess its long term outcome.
Section snippets
Patient selection
This was a prospective non-randomised single-centre study. Institutional Review Board (IRB) approval was obtained before commencement of the study. A total of 48 patients, aged 20–65, diagnosed with plantar fasciitis, were enrolled in the study. There were 18 men and 30 women. A total of 59 feet were treated, 32 right feet and 27 left feet.
Most patients presented with heel pain, resulting from repetitive trauma to the plantar fascia, usually from an activity related to work or sports. Study
Results
The procedures were performed on a total of 59 feet, with a mean age of 43 years (range 20.2–65.1 years). There were 38 female feet and 21 male feet. The open approach was taken in 32 feet and the percutaneous approach in 27 feet.
There were 40 feet at 3 months’ follow-up, 45 feet at 6 months’, and 21 feet at the 12-month follow-up visit.
Discussion
It is well documented that plantar fasciitis largely resolves with conservative therapy, yet there remains a significant minority of patients for whom this is insufficient. Our study focuses on this group of patients.
Conventional surgery for these patients would involve partial plantar fascial release, resection or debridement of the affected part of the plantar fascia. Multiple studies have placed success rates for surgical intervention between 70% and 90% [35], [36], [37], [38], [39], [40],
Conflict of interest statement
None of the authors have any conflicts of interest to declare.
Acknowledgement
There were no additional sources of funding and no contributors other than the authors were involved in this study.
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Development of Multiple Epidermal Inclusion Cysts After Radiofrequency Microtenotomy for Plantar Fasciitis: A Case Report
2021, Journal of Foot and Ankle SurgeryCitation Excerpt :In a study comparing the open to the percutaneous technique for radiofrequency coblation for plantar fasciitis, Tay et al concluded that patients who had undergone the open technique experienced superior outcomes, namely decreased pain, as compared to the percutaneously treated group. They determined this was an effective alternative to surgical release and no complications were noted per the authors using either technique at 1 year (12). Radiofrequency microtenotomy is generally regarded to be a safe procedure with low complication rate (12,14,15).
Percutaneous Plantar Fascia Release With Needle: Anatomic Evaluation with Cadaveric Specimens
2019, Journal of Foot and Ankle SurgeryUltrasound-Guided Pulsed Radiofrequency Stimulation of Posterior Tibial Nerve: A Potential Novel Intervention for Recalcitrant Plantar Fasciitis
2017, Archives of Physical Medicine and RehabilitationPercutaneous planter fasciitis release under local anesthesia: A prospective study
2017, Chinese Journal of Traumatology - English EditionCitation Excerpt :However, partial and especially total release of the plantar fascia results in instability of the medial column of the foot, along with lateral column overload and pain.3,4 Overall, a surgical release has a 70%–90% success rate in treating patients with this condition.5–7 A study found that endoscopic plantar fascia release provides significantly improved outcomes for patients, especially those with less severe symptoms.8,9
Radiofrequency microtenotomy is as effective as plantar fasciotomy in the treatment of recalcitrant plantar fasciitis
2016, Foot and Ankle SurgeryCitation Excerpt :Given its success with treating Achilles tendinosis and other fascioses, radiofrequency coblation has been proposed as a minimally invasive treatment modality for chronic plantar fasciitis [1,2,8,11–20]. Radiofrequency coblation induces epidermal destruction with minimal thermal damage, resulting in improved healing through controlled inflammation and focal angiogenesis [1,2,8,11,12,16,20]. Immunoreactivity studies have shown treated tissue to exhibit higher levels of biochemical markers of angiogenesis, while histological studies have shown more increased neovascularization and regeneration of sensory nerve fibers in animal studies, suggesting the technique may be helpful in treating plantar fasciitis [1,2,11,12,20].