Assessing The Role Of Radiofrequency Nerve Ablation For Plantar Fasciitis

Author(s): 
Adam Landsman, DPM, FACFAS, PhD

   Cozzarelli and colleagues conducted the largest study to date involving the treatment of plantar fasciitis with radiofrequency nerve ablation.8 The study of 82 patients with up to 12 years of follow-up showed an 89 percent success rate. The same article reports details of the authors’ technique and involves a more detailed explanation of their method for nerve localization. According to their description, these investigators will attempt to pinpoint each area of pain individually around the heel region and then perform individual ablations. Although this approach may be more laborious, it may increase the chances of success since the treatment targets a greater area.

   More recently, my group has submitted a study to the Journal of the American Podiatric Medical Association and the study involves a prospective evaluation of patients who were randomly assigned to active or placebo treatment. Those who did not respond received the opportunity to cross over. We found that those who received active treatment demonstrated dramatic improvement within the first month while those who received placebo showed no statistically significant improvement. This manuscript is under peer review at this time.

How Does Radiofrequency Nerve Ablation Stack Up To The Alternatives?

Many alternatives exist for the treatment of common plantar fasciitis. Treatments such as corticosteroid injections, extracorporeal shockwave therapy (ESWT), partial surgical release of the plantar fascia, physical therapy, arch supports and behavior modifications are all known to provide some level of relief.

   However, there are associated risks with many of these treatments. Corticosteroid injections may lead to irreversible soft tissue atrophy.9 Partial release of the plantar fascia can cause collapse of the arch, cuboid crush symptoms and painful scar formation.10 Shockwave can be quite expensive and research has shown ESWT to produce a significant reduction of symptoms in approximately 50 percent of the cases following a single treatment.11

   The risks associated with radiofrequency nerve ablation are comparatively low and the clinical outcomes are generally much higher. Although radiofrequency nerve ablation does give relief to those afflicted with inflammation at the origin of the plantar fascia, it is also beneficial for those with scar related heel pain, calcaneal bursitis, nerve entrapments and even fat pad atrophy. Furthermore, radiofrequency nerve ablation does not diminish the strength of the plantar fascia in any way and therefore will not result in medial arch collapse or cuboid crush conditions.

   The types of complications associated with radiofrequency nerve ablation center around the types of problems normally associated with a standard injection. These problems may include a hematoma at the injection site. Also in some cases, one may have to repeat the procedure if the probe was not close enough to the affected nerve at the time of ablation.

Why Radiofrequency Nerve Ablation Has Become A ‘Treatment Of Choice’ For The Author

Due to the safety profile, proven efficacy and the ease of the procedure, radiofrequency nerve ablation is becoming my treatment of choice rather than a go-to treatment when all else has failed. In over 80 percent of cases, I have found that patients get almost complete relief within one month following a single treatment that normally occurs in the office.

   I have found that the safety profile is outstanding with no worsening of the condition and no significant adverse events. The most common complication was bruising at the injection site.

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