Bipolar Radiofrequency Microtenotomy: Can It Be An Effective Alternative For Plantar Fasciosis?

Bora Rhim, DPM

How Bipolar Radiofrequency Works

When surgical intervention is necessary to treat recalcitrant plantar fasciosis, bipolar radiofrequency microtenotomy (Topaz MicroDebrider, ArthroCare Sports Medicine) can provide an alternative to the invasive procedures. Radiofrequency microtenotomy initially started in the orthopedic field for the treatment of tendinosis and has been successful in the treatment of tennis elbow and rotator cuff tendinosis.    In theory, the bipolar radiofrequency microtenotomy technique stimulates angiogenesis to the avascular, fibrotic and degenerative fascia. This technique appears to be an optimal treatment approach for tendinosis/fasciosis as it reportedly stimulates and organizes the angiogenic healing response to attempt to reverse this condition. Research has shown this technique promotes angiogenesis in ischemic hearts in patients with congenital heart failure and accelerates wound healing to enhance cell proliferation.9 The bipolar radiofrequency system works by increasing fibroblastic growth factor, vascular endothelial growth factor and vascular cells.10 The possibility for treatment of a tendinosis/fasciosis by a radiofrequency based approach might therefore be valuable.    There are several benefits to utilizing Topaz in treating plantar fasciosis. It is technically easy to perform and is much less invasive than conventional surgery, which allows early ambulation with rehabilitation. This device works by using a controlled plasma-mediated radiofrequency process called Coblation. The radiofrequency energy works through a conductive medium such as electrolyte (saline) solution, producing excited radicals within precisely focused plasma. In the plasma, the energized particles generate sufficient energy to break up covalent molecular bonds, resulting in the ablation of soft tissues at relatively low temperatures.9,10

A Step-By-Step Guide To Treatment

One would perform the procedure with the patient in a supine position, using an ankle pneumatic tourniquet and sterile preparation for the foot. Administer a medial calcaneal nerve block with local anesthetic. Preoperatively, mark the area of tenderness on the plantar heel. Then using a grid-like pattern, place a series of holes through the area of tenderness, spacing them 5 mm apart. Usually, the treating physician places a maximum of 20 holes within the affected area of the heel.    Use a smooth 0.062-inch Kirschner wire to puncture the skin in a percutaneous fashion at the marked areas around the affected area of the heel. Perform the microtenotomy by using the Topaz wand until resistance occurs and then apply the radiofrequency. Advance the wand through the fascia at varied depth when using radiofrequency.    In regard to the postoperative regimen, one should emphasize full weightbearing in a controlled ankle motion (CAM) walker at day one. The patient continues using a CAM walker for one to two weeks. A few days after the procedure, encourage patients to remove the CAM walker for stretching exercises.

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