November 2010

Study Assesses Long-Term Results Of Radiofrequency Nerve Ablation

By Brian McCurdy, Senior Editor

After patients have failed conservative treatment for plantar fasciitis, radiofrequency nerve ablation (RFNA) may be an effective option. A recent study in Foot and Ankle Specialist notes that patients have been pain free for up to 12 years after RFNA.

   The retrospective review focused on 82 patients who had undergone radiofrequency nerve ablation for neurogenic heel pain. Follow-up occurred at five, 10 and 12 years, and 89 percent of patients experienced no recurrent pain at these follow-up points, according to the study.

   In his use of RFNA, Adam Landsman, DPM, PhD, has found results similar to that of the study but notes that his longest follow-up is five years. He has found “nearly complete resolution of symptoms” in about 80 percent of patients with no recurrence of symptoms. Some patients experience some improvement right away but he notes that it takes four to 12 weeks after the procedure to appreciate the full benefits. Dr. Landsman notes that last year he published a randomized, prospective, blinded study in the Journal of Foot and Ankle Surgery, which “clearly supports” the benefits of this procedure.

   Most of Dr. Landsman’s RFNA patients have previously failed conservative modalities and some surgical procedures before undergoing RFNA.

    “I think that the real question here is, ‘Why do we wait so long to do the procedure?’ There are few potential complications and the treatment works rapidly and lasts a long time,” says Dr. Landsman, an Assistant Professor of Surgery at Harvard Medical School in Cambridge, Mass. “It does not cause any biomechanical problems. In the worst case, it may not work but it does not seem to ever increase pain.”

   Stephen Barrett, DPM, cites the importance of the authors’ conclusion that there is a high association with plantar fasciosis and nerve entrapment of the medial calcaneal nerve(s). Furthermore, he says it is critical that the study authors established a neural etiology in all of their patients.

    “This is a big difference that has been obfuscated by nearly all discussions of heel pain. The most frequent etiology in heel pain is plantar fasciopathy (a true musculoskeletal condition). However, there are many cases of multiple etiology heel pain and many cases in which there is a diagnosis of plantar fasciopathy that is in reality solely neurogenic,” points out Dr. Barrett, an Adjunct Professor at the Arizona Podiatric Medical Program at Midwestern University College of Health Sciences.

   Although he has previously criticized nerve ablation for plantar fasciopathy, Dr. Barrett says the modality does have a role for patients in whom the entrapment of the medial calcaneal nerve is the primary pain generator. He does caution that RFNA causes a peripheral nerve injury and serious complications can develop with any such modality.

Should You Use A General Anesthetic With RFNA?

Dr. Landsman was surprised the study authors used a general anesthetic as patient feedback is a critical part of correct probe placement. For RFNA, he uses the NeuroTherm NT250 (NeuroTherm) and the device’s built-in sensory stimulator. He asks the patient for feedback to ensure he has located the proper nerve.

   Dr. Landsman was also surprised about the study’s finding of reduced impedance in the presence of local anesthetic. He says the NeuroTherm device allows the measurement of impedance. The next time Dr. Landsman performs this procedure, he notes that will locate the nerve, measure impedance, infiltrate the area with local anesthetic and measure the impedance again.

    “I have always done this procedure with local infiltration and have had great success so this may even give me greater improvement,” says Dr. Landsman.

Is Probe To Bone The Best Test For Osteomyelitis In DFUs?

By Brian McCurdy, Senior Editor

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