Open technique is more effective than percutaneous technique for TOPAZ radiofrequency coblation for plantar fasciitis

Abstract

Background

Microtenotomy coblation using a radiofrequency (RF) probe is a minimally invasive procedure for treating chronic tendinopathy. It has been described for conditions including tennis elbow and rotator cuff tendinitis. There have been no long term studies to show its effectiveness in plantar fasciitis.

Methods

A prospective non-randomised trial was conducted on 48 patients who had failed conservative treatment for plantar fasciitis, between 2007 and 2009. The procedure was performed using the TOPAZ microdebrider device (ArthroCare, Sunnyvale, CA), either via an open or a percutaneous method. Fifty-nine feet were treated and followed up for up to 1 year thereafter. Preoperative, 3, 6 and 12 months post-operative VAS pain, American Orthopaedic Foot-Ankle Society (AOFAS) hindfoot and SF-36 scores, patient expectation and satisfaction scores were analysed.

Results

VAS scores improved significantly in both groups at 1-year follow-up. The open group had a more significant improvement in the VAS score at 1-year follow-up. AOFAS hindfoot scores improve significantly for both groups pre- and post-operatively, but there was no significant difference between both groups at the 1-year mark. SF-36 scores showed equally significant improvement in both groups 1 year post-operatively. Expectation and satisfaction scores were equally high in both arms.

Conclusions

TOPAZ RF coblation is a good and effective method for the treatment of recalcitrant plantar fasciitis. Clinical results improve with time for up to 1-year post-operatively. The open method seems to have a more significant improvement in pain VAS scores at 1-year postoperatively.

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.