Bipolar Radiofrequency Microtenotomy: Can It Be An Effective Alternative For Plantar Fasciosis?
What The Research Says About Topaz Results
Using the Topaz system, numerous researchers have reported good pain control with early improvement in pain and functional scores.9-11 This technique allows the surgeon to avoid cutting the plantar fascia and reduce the risk of complete rupture to the ligament. There are some concerns over jeopardizing ligament integrity with the use of the Coblation technique in areas of high stress and repetitive loading. Silver and colleagues performed a cadaveric study and found no difference in stress, elastic modulus, energy strain density or strain at maximal load of patellar tendons treated with bipolar radiofrequency.12 It is speculated that in vivo specimens would attain similar results although no published reports currently exist to support or refute this study. Radiofrequency techniques have substantially increased localized vessel counts between three and nine weeks after the procedure.10 In addition, plasma-mediated therapy in this study resulted in a more localized inflammatory response in vivo in comparison to conventional electrosurgery. There are limited published results regarding the treatment of plantar fasciosis using bipolar radiofrequency. Weil and colleagues published a small case series of 10 patients who underwent percutaneous microtenotomy after failing conservative care and used a visual analog scale (VAS) and the American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot and Midfoot Scale to assess patient satisfaction.11 Patient assessments occurred at six months and one year after surgery. Ninety percent reported they were “extremely satisfied” to “satisfied” with their outcome. However, one patient developed recurrent heel pain one year after the procedure. There were no postoperative complications reported. Sean and colleagues reported on 14 patients with plantar fasciitis who were treated with Coblation from 2007 to 2008.10 When comparing preoperative and postoperative AOFAS Hindfoot and SF-36 scores, authors reported improvement from 34.47 to 69.27 and 71.33. There was a decrease in SF-36 score for bodily pain and an increase in physical and social function scores. The study found 85.7 percent of patients reported good to excellent results six months after surgery. Sean and co-authors also reported no complications.10 There is a concern that bipolar radiofrequency could potentially cause excessive adjacent tissue damage.9 However, Kaplan and Uribe showed that chondrocytes still remain viable immediately below the surface of the radiofrequency treatment area.13
Other Considerations With The Bipolar Radiofrequency Microtenotomy
There are several considerations to keep in mind when treating plantar fasciosis with the radiofrequency technique. If the patient has inadequate dorsiflexion to the ankle, one should consider an adjunct procedure such as gastroc lengthening. If the patient has biomechanical faults that are contributing to the symptoms of plantar fasciosis that are causing severe tension to the plantar fascia, then consider surgical treatment that reduces the tension to the plantar fascia or custom orthotics after the surgery. To develop a more comprehensive understanding of the effects of bipolar radiofrequency, additional research is required. A serial examination of in vivo samples treated with Coblation would yield powerful data to help delineate its potential role in tendon or ligamentous degeneration. In addition, a study with a larger clinical group with longer follow-up is necessary to understand the long-term effects of this technology upon the natural history of plantar fasciosis. With careful patient selection and adherence to the recommended technique, bipolar radiofrequency microtenotomy offers the patient and practitioner hope in the treatment of chronic plantar fasciosis.