A NEW TREND IN ORTHOPEDICS: RADIOFREQUENCY ABLATION FOR THE TREATMENT OF INTRACTABLE PLANTAR FASCIITIS
Year 2024,
Volume: 38 Issue: 2, 73 - 82, 28.08.2024
Toktamış Savaş
,
Sezgin B. Tekin
,
Edip Gönüllü
,
Çağrı Karabulut
Abstract
BACKGROUND: One of the most common causes of pain in the plantar region of the foot is plantar fasciitis (PF), for which there are numerous treatment options. Several invasive and non-invasive treatment modalities have been developed for this condition. One of these options for patients who do not respond to conservative treatment is radiofrequency ablation (RFA). Due to its early functional benefits and minimally invasive nature, RFA is believed to achieve successful clinical outcomes in patients with persistent early-stage PF. This study aims to evaluate the efficacy and clinical outcomes of RFA in the treatment of PF.
METHODS: A total of 35 patients (46 feet), aged 31-50 years, who were treated with RFA from December 2018 to December 2019 were included in the study. AOFAS (American Orthopaedic Foot & Ankle Society) and Visual Analog Scale (VAS) of patients who received conservative treatment for 3 months or longer and whose complaints persisted were pre-treatment (PrT) of RFA. These scores were re-evaluated after 3 months.
RESULTS: Among the patients in the study, 10 (28.57%) were male and 25 (71.43%) were female. The mean age of the patients was 40.43±5.37 years. The PrT and post-treatment (PsT) VAS scores were 8.97±1.36 and 5.89±3.66, respectively. The PrT and PsT AOFAS scores were 48.51±10.67 and 65.86±22.74, respectively. Statistical analyses showed that the clinical outcomes of RFA were significantly improved after treatment for both scores (p<0.05).
CONCLUSION: RFA, which is rapidly and long-term effective without disrupting the plantar fascia anatomy, is an important minimally invasive treatment option that can be preferred in patients with chronic PF.
Ethical Statement
The study protocol was approved by Scientific Research Ethics Committee of Gaziantep University Medical Faculty and the study was conducted in accordance with Declaration of Helsinki.
References
- 1. Jain SK, Suprashant K, Kumar S, Yadav A, Kearns SR (2018) Comparison of Plantar Fasciitis Injected With Platelet-Rich Plasma vs Corticosteroids. Foot Ankle Int.7:780-6 https://doi.org/10.1177/1071100718762406.
- 2. Lemont H, Ammirati KM, Usen N (2003) Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc.3:234-7 https://doi.org/10.7547/87507315-93-3-234.
- 3. Nery C, Raduan F, Mansur N, Baunfeld D, Del Buono A, Maffulli N (2013) Endoscopic approach for plantar fasciopathy: a long-term retrospective study. Int Orthop.6:1151-6 https://doi.org/10.1007/s00264-013-1847-z.
- 4. Trojian T, Tucker AK (2019) Plantar Fasciitis. Am Fam Physician.12:744-50
- 5. Atkins D, Crawford F, Edwards J, Lambert M (1999) A systematic review of treatments for the painful heel. Rheumatology (Oxford).10:968-73 https://doi.org/10.1093/rheumatology/38.10.968.
- 6. Crawford F, Thomson C (2003) Interventions for treating plantar heel pain. Cochrane Database Syst Rev.3:Cd000416 https://doi.org/10.1002/14651858.Cd000416.
- 7. Wolgin M, Cook C, Graham C, Mauldin D (1994) Conservative treatment of plantar heel pain: long-term follow-up. Foot Ankle Int.3:97-102 https://doi.org/10.1177/107110079401500303.
- 8. Gill LH, Kiebzak GM (1996) Outcome of nonsurgical treatment for plantar fasciitis. Foot Ankle Int.9:527-32 https://doi.org/10.1177/107110079601700903.
- 9. Banerjee R, Chao JC, Taylor R, Siddiqui A (2012) Management of calcaneal tuberosity fractures. J Am Acad Orthop Surg.4:253-8 https://doi.org/10.5435/jaaos-20-04-253.
- 10. DiGiovanni BF, Moore AM, Zlotnicki JP, Pinney SJ (2012) Preferred management of recalcitrant plantar fasciitis among orthopaedic foot and ankle surgeons. Foot Ankle Int.6:507-12 https://doi.org/10.3113/fai.2012.0507.
- 11. Yin MC, Ye J, Yao M, Cui XJ, Xia Y, Shen QX, et al. (2014) Is extracorporeal shock wave therapy clinical efficacy for relief of chronic, recalcitrant plantar fasciitis? A systematic review and meta-analysis of randomized placebo or active-treatment controlled trials. Arch Phys Med Rehabil.8:1585-93 https://doi.org/10.1016/j.apmr.2014.01.033.
- 12. Cottom JM, Baker JS (2016) Endoscopic Plantar Fascia Debridement for Chronic Plantar Fasciitis. Clin Podiatr Med Surg.4:545-51 https://doi.org/10.1016/j.cpm.2016.06.004.
- 13. Franceschi F, Papalia R, Franceschetti E, Paciotti M, Maffulli N, Denaro V (2014) Platelet-rich plasma injections for chronic plantar fasciopathy: a systematic review. Br Med Bull.1:83-95 https://doi.org/10.1093/bmb/ldu025.
- 14. Ordahan B, Karahan AY, Kaydok E (2018) The effect of high-intensity versus low-level laser therapy in the management of plantar fasciitis: a randomized clinical trial. Lasers Med Sci.6:1363-9 https://doi.org/10.1007/s10103-018-2497-6.
- 15. Chou AC, Ng SY, Su DH, Singh IR, Koo K (2016) Radiofrequency microtenotomy is as effective as plantar fasciotomy in the treatment of recalcitrant plantar fasciitis. Foot Ankle Surg.4:270-3 https://doi.org/10.1016/j.fas.2015.11.006.
- 16. Li XY, Yan L, Xiao J, Li YY, Yang Z, Zhang MB, et al. (2023) Follow-up strategy of radiofrequency ablation for papillary thyroid microcarcinoma: defining a response-to-ablation system. European Radiology. https://doi.org/10.1007/s00330-023-10022-6.
- 17. Habibi M, Berger RD, Calkins H (2021) Radiofrequency ablation: technological trends, challenges, and opportunities. Europace.4:511-9 https://doi.org/10.1093/europace/euaa328.
- 18. Orhurhu V, Huang LS, Quispe RC, Khan F, Karri J, Urits I, et al. (2021) Use of Radiofrequency Ablation for the Management of Headache: A Systematic Review. Pain Physician.7:E973-E87
- 19. Tracey I (2008) Imaging pain. British Journal of Anaesthesia.1:32-9 https://doi.org/10.1093/bja/aen102.
- 20. Cardenuto Ferreira R (2014) Talalgia: plantar fasciitis. Rev Bras Ortop.3:213-7 https://doi.org/10.1016/j.rboe.2014.03.012.
- 21. Weihs AM, Fuchs C, Teuschl AH, Hartinger J, Slezak P, Mittermayr R, et al. (2014) Shock Wave Treatment Enhances Cell Proliferation and Improves Wound Healing by ATP Release-coupled Extracellular Signal-regulated Kinase (ERK) Activation *. Journal of Biological Chemistry.39:27090-104 https://doi.org/10.1074/jbc.M114.580936.
- 22. Ryskalin L, Morucci G, Natale G, Soldani P, Gesi M (2022) Molecular Mechanisms Underlying the Pain-Relieving Effects of Extracorporeal Shock Wave Therapy: A Focus on Fascia Nociceptors. Life-Basel.5 https://doi.org/10.3390/life12050743.
- 23. David JA, Sankarapandian V, Christopher PRH, Chatterjee A, Macaden AS (2017) Injected corticosteroids for treating plantar heel pain in adults. Cochrane Database of Systematic Reviews.6 https://doi.org/10.1002/14651858.CD009348.pub2.
- 24. Singh P, Madanipour S, Bhamra JS, Gill I (2017) A systematic review and meta-analysis of platelet-rich plasma versus corticosteroid injections for plantar fasciopathy. International Orthopaedics.6:1169-81 https://doi.org/10.1007/s00264-017-3470-x.
- 25. Wu PT, Lee JS, Wu KC, Wu TT, Shao CJ, Liang FW, et al. (2016) Ultrasound-Guided Percutaneous Radiofrequency Lesioning When Treating Recalcitrant Plantar Fasciitis: Clinical Results. Ultraschall in Der Medizin.1:56-62 https://doi.org/10.1055/s-0034-1385466.
- 26. Cione JA, Cozzarelli J, Mullin CJ (2009) A Retrospective Study of Radiofrequency Thermal Lesioning for the Treatment of Neuritis of the Medial Calcaneal Nerve and its Terminal Branches in Chronic Heel Pain. Journal of Foot & Ankle Surgery.2:142-7 https://doi.org/10.1053/j.jfas.2008.11.007.
- 27. Yalcin E, Akca AK, Selcuk B, Kurtaran A, Akyuz M (2012) Effects of extracorporal shock wave therapy on symptomatic heel spurs: a correlation between clinical outcome and radiologic changes. Rheumatology International.2:343-7 https://doi.org/10.1007/s00296-010-1622-z.
- 28. Kurtoglu A, Kochai A, Inanmaz ME, Sukur E, Keskin D, Türker M, et al. (2022) Effectiveness of radiofrequency ablation for treatment of plantar fasciitis. Medicine.12 https://doi.org/10.1097/md.0000000000029142.
- 29. Yürük D, Karlibel IA, Aksoy MK (2022) The effectiveness of conventional radiofrequency ablation for chronic plantar heel pain due to heel spur. Agri-the Journal of the Turkish Society of Algology.2:131-8 https://doi.org/10.14744/agri.2021.82542.
ORTOPEDİDE YENİ BİR TREND: İNATÇI PLANTAR FASİT TEDAVİSİ İÇİN RADYOFREKANS ABLASYON
Year 2024,
Volume: 38 Issue: 2, 73 - 82, 28.08.2024
Toktamış Savaş
,
Sezgin B. Tekin
,
Edip Gönüllü
,
Çağrı Karabulut
Abstract
AMAÇ: Ayağın plantar bölgesindeki ağrının en yaygın nedenlerinden biri olan plantar fasiit (PF) için çok sayıda tedavi seçeneği bulunmaktadır. Bu durum için çeşitli invaziv ve non-invaziv tedavi yöntemleri geliştirilmiştir. Konservatif tedaviye yanıt vermeyen hastalar için bu seçeneklerden biri radyofrekans ablasyondur (RFA). Erken fonksiyonel faydaları ve minimal invaziv doğası nedeniyle, RFA'nın inatçı erken evre PF'li hastalarda başarılı klinik sonuçlar elde ettiğine inanılmaktadır. Bu çalışma, RFA'nın PF tedavisindeki etkinliğini ve klinik sonuçlarını değerlendirmeyi amaçlamaktadır.
GEREÇ ve YÖNTEM: Çalışmaya Aralık 2018'den Aralık 2019'a kadar RFA ile tedavi edilen 31-50 yaş arası toplam 35 hasta (46 ayak) dahil edildi. RFA öncesi (PrT) 3 ay veya daha uzun süre konservatif tedavi alan ve şikayetleri devam eden hastaların AOFAS (American Orthopaedic Foot & Ankle Society) ve Görsel Analog Skalası (VAS) değerlendirildi. Bu skorlar RFA sonrası (PsT) 3 ay sonra tekrar değerlendirilmiştir.
BULGUAR: Çalışmaya katılan hastaların 10'u (%28.57) erkek, 25'i (%71.43) kadındı. Hastaların yaş ortalaması 40.43±5.37 yıl idi. Tedavi öncesi ve sonrası VAS skorları sırasıyla 8.97±1.36 ve 5.89±3.66 idi. PrT ve PsT AOFAS skorları sırasıyla 48.51±10.67 ve 65.86±22.74 idi. İstatistiksel analizler RFA'nın klinik sonuçlarının her iki skor için de tedavi sonrasında anlamlı olarak iyileştiğini gösterdi (p<0.05).
SONUÇ: Plantar fasya anatomisini bozmadan hızlı ve uzun süreli etkili olan RFA, kronik PF'li hastalarda tercih edilebilecek önemli bir minimal invaziv tedavi seçeneğidir.
References
- 1. Jain SK, Suprashant K, Kumar S, Yadav A, Kearns SR (2018) Comparison of Plantar Fasciitis Injected With Platelet-Rich Plasma vs Corticosteroids. Foot Ankle Int.7:780-6 https://doi.org/10.1177/1071100718762406.
- 2. Lemont H, Ammirati KM, Usen N (2003) Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc.3:234-7 https://doi.org/10.7547/87507315-93-3-234.
- 3. Nery C, Raduan F, Mansur N, Baunfeld D, Del Buono A, Maffulli N (2013) Endoscopic approach for plantar fasciopathy: a long-term retrospective study. Int Orthop.6:1151-6 https://doi.org/10.1007/s00264-013-1847-z.
- 4. Trojian T, Tucker AK (2019) Plantar Fasciitis. Am Fam Physician.12:744-50
- 5. Atkins D, Crawford F, Edwards J, Lambert M (1999) A systematic review of treatments for the painful heel. Rheumatology (Oxford).10:968-73 https://doi.org/10.1093/rheumatology/38.10.968.
- 6. Crawford F, Thomson C (2003) Interventions for treating plantar heel pain. Cochrane Database Syst Rev.3:Cd000416 https://doi.org/10.1002/14651858.Cd000416.
- 7. Wolgin M, Cook C, Graham C, Mauldin D (1994) Conservative treatment of plantar heel pain: long-term follow-up. Foot Ankle Int.3:97-102 https://doi.org/10.1177/107110079401500303.
- 8. Gill LH, Kiebzak GM (1996) Outcome of nonsurgical treatment for plantar fasciitis. Foot Ankle Int.9:527-32 https://doi.org/10.1177/107110079601700903.
- 9. Banerjee R, Chao JC, Taylor R, Siddiqui A (2012) Management of calcaneal tuberosity fractures. J Am Acad Orthop Surg.4:253-8 https://doi.org/10.5435/jaaos-20-04-253.
- 10. DiGiovanni BF, Moore AM, Zlotnicki JP, Pinney SJ (2012) Preferred management of recalcitrant plantar fasciitis among orthopaedic foot and ankle surgeons. Foot Ankle Int.6:507-12 https://doi.org/10.3113/fai.2012.0507.
- 11. Yin MC, Ye J, Yao M, Cui XJ, Xia Y, Shen QX, et al. (2014) Is extracorporeal shock wave therapy clinical efficacy for relief of chronic, recalcitrant plantar fasciitis? A systematic review and meta-analysis of randomized placebo or active-treatment controlled trials. Arch Phys Med Rehabil.8:1585-93 https://doi.org/10.1016/j.apmr.2014.01.033.
- 12. Cottom JM, Baker JS (2016) Endoscopic Plantar Fascia Debridement for Chronic Plantar Fasciitis. Clin Podiatr Med Surg.4:545-51 https://doi.org/10.1016/j.cpm.2016.06.004.
- 13. Franceschi F, Papalia R, Franceschetti E, Paciotti M, Maffulli N, Denaro V (2014) Platelet-rich plasma injections for chronic plantar fasciopathy: a systematic review. Br Med Bull.1:83-95 https://doi.org/10.1093/bmb/ldu025.
- 14. Ordahan B, Karahan AY, Kaydok E (2018) The effect of high-intensity versus low-level laser therapy in the management of plantar fasciitis: a randomized clinical trial. Lasers Med Sci.6:1363-9 https://doi.org/10.1007/s10103-018-2497-6.
- 15. Chou AC, Ng SY, Su DH, Singh IR, Koo K (2016) Radiofrequency microtenotomy is as effective as plantar fasciotomy in the treatment of recalcitrant plantar fasciitis. Foot Ankle Surg.4:270-3 https://doi.org/10.1016/j.fas.2015.11.006.
- 16. Li XY, Yan L, Xiao J, Li YY, Yang Z, Zhang MB, et al. (2023) Follow-up strategy of radiofrequency ablation for papillary thyroid microcarcinoma: defining a response-to-ablation system. European Radiology. https://doi.org/10.1007/s00330-023-10022-6.
- 17. Habibi M, Berger RD, Calkins H (2021) Radiofrequency ablation: technological trends, challenges, and opportunities. Europace.4:511-9 https://doi.org/10.1093/europace/euaa328.
- 18. Orhurhu V, Huang LS, Quispe RC, Khan F, Karri J, Urits I, et al. (2021) Use of Radiofrequency Ablation for the Management of Headache: A Systematic Review. Pain Physician.7:E973-E87
- 19. Tracey I (2008) Imaging pain. British Journal of Anaesthesia.1:32-9 https://doi.org/10.1093/bja/aen102.
- 20. Cardenuto Ferreira R (2014) Talalgia: plantar fasciitis. Rev Bras Ortop.3:213-7 https://doi.org/10.1016/j.rboe.2014.03.012.
- 21. Weihs AM, Fuchs C, Teuschl AH, Hartinger J, Slezak P, Mittermayr R, et al. (2014) Shock Wave Treatment Enhances Cell Proliferation and Improves Wound Healing by ATP Release-coupled Extracellular Signal-regulated Kinase (ERK) Activation *. Journal of Biological Chemistry.39:27090-104 https://doi.org/10.1074/jbc.M114.580936.
- 22. Ryskalin L, Morucci G, Natale G, Soldani P, Gesi M (2022) Molecular Mechanisms Underlying the Pain-Relieving Effects of Extracorporeal Shock Wave Therapy: A Focus on Fascia Nociceptors. Life-Basel.5 https://doi.org/10.3390/life12050743.
- 23. David JA, Sankarapandian V, Christopher PRH, Chatterjee A, Macaden AS (2017) Injected corticosteroids for treating plantar heel pain in adults. Cochrane Database of Systematic Reviews.6 https://doi.org/10.1002/14651858.CD009348.pub2.
- 24. Singh P, Madanipour S, Bhamra JS, Gill I (2017) A systematic review and meta-analysis of platelet-rich plasma versus corticosteroid injections for plantar fasciopathy. International Orthopaedics.6:1169-81 https://doi.org/10.1007/s00264-017-3470-x.
- 25. Wu PT, Lee JS, Wu KC, Wu TT, Shao CJ, Liang FW, et al. (2016) Ultrasound-Guided Percutaneous Radiofrequency Lesioning When Treating Recalcitrant Plantar Fasciitis: Clinical Results. Ultraschall in Der Medizin.1:56-62 https://doi.org/10.1055/s-0034-1385466.
- 26. Cione JA, Cozzarelli J, Mullin CJ (2009) A Retrospective Study of Radiofrequency Thermal Lesioning for the Treatment of Neuritis of the Medial Calcaneal Nerve and its Terminal Branches in Chronic Heel Pain. Journal of Foot & Ankle Surgery.2:142-7 https://doi.org/10.1053/j.jfas.2008.11.007.
- 27. Yalcin E, Akca AK, Selcuk B, Kurtaran A, Akyuz M (2012) Effects of extracorporal shock wave therapy on symptomatic heel spurs: a correlation between clinical outcome and radiologic changes. Rheumatology International.2:343-7 https://doi.org/10.1007/s00296-010-1622-z.
- 28. Kurtoglu A, Kochai A, Inanmaz ME, Sukur E, Keskin D, Türker M, et al. (2022) Effectiveness of radiofrequency ablation for treatment of plantar fasciitis. Medicine.12 https://doi.org/10.1097/md.0000000000029142.
- 29. Yürük D, Karlibel IA, Aksoy MK (2022) The effectiveness of conventional radiofrequency ablation for chronic plantar heel pain due to heel spur. Agri-the Journal of the Turkish Society of Algology.2:131-8 https://doi.org/10.14744/agri.2021.82542.