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Yildiz G, Perdecioglu GRG, Yuruk D, Can E, Akkaya OT. Comparison of tibial nerve pulsed radiofrequency and intralesional radiofrequency thermocoagulation in the treatment of painful calcaneal spur and plantar fasciitis: a randomized clinical trial. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:493-499. [PMID: 38652568 DOI: 10.1093/pm/pnae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/07/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Ultrasound-guided tibial nerve pulsed radiofrequency (US-guided TN PRF) and fluoroscopy-guided intralesional radiofrequency thermocoagulation (FL-guided intralesional RFT) adjacent to the painful calcaneal spur are two interventions for pain management in painful calcaneal spur and plantar fasciitis. This study aimed to compare the effectiveness of the two procedures. DESIGN A prospective, randomized, single-blind study. SETTING Single-center pain clinic. SUBJECTS Forty-nine patients who met the inclusion criteria were randomized into two groups. METHODS Group U (25 patients) received US-guided TN PRF at 42°C for 240 s, whereas Group F (24 patients) received FL-guided intralesional RFT at 80°C for 90 s. The most severe numeric rating scale (NRS) score during the first morning steps and the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were used to evaluate the effectiveness of the procedures. The study's primary outcome assessed treatment effectiveness via the NRS, whereas the secondary outcomes included changes in the AOFAS score and the incidence of procedure-related mild adverse events. RESULTS NRS and AOFAS scores significantly improved in Groups U and F at 1 and 3 months compared with baseline (P < .05), and there was no significant difference between the groups. At month 1, 50% or greater pain relief was achieved in 72% of patients in Group U and 75% of patients in Group F. No significant difference was observed in the incidence of mild adverse events between the groups. CONCLUSIONS US-guided TN PRF and FL-guided intralesional RFT have shown significant effectiveness in the treatment of painful calcaneal spur and plantar fasciitis. Larger randomized controlled trials are needed. CLINICAL TRIAL NUMBER NCT06240507.
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Affiliation(s)
- Gokhan Yildiz
- Department of Algology, Ankara Etlik City Hospital, 6010 Ankara, Turkey
| | | | - Damla Yuruk
- Department of Algology, Ankara Etlik City Hospital, 6010 Ankara, Turkey
| | - Ezgi Can
- Department of Algology, Ankara Etlik City Hospital, 6010 Ankara, Turkey
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Kanesen K, Jaafar MS, Alias A, Kam ML, Yahaya MYB. A Multi-centered Retrospective Study on the Efficacy of Pulsed Radiofrequency Nerve Ablation in the Treatment of Recalcitrant Plantar Fasciitis: A Mid-term Outcome. Cureus 2024; 16:e58021. [PMID: 38738017 PMCID: PMC11088475 DOI: 10.7759/cureus.58021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
Background Plantar fasciitis, a condition marked by persistent and often excruciating heel pain, frequently poses a formidable hurdle when conservative treatment approaches fall short. This multi-centered retrospective study embarks on a journey to explore the potential effectiveness of pulsed radiofrequency nerve ablation (RFNA), an innovative and less invasive procedure, as a novel avenue for treating recalcitrant plantar fasciitis. This investigation centers around a group of 24 patients who have faced the persistence of this challenging ailment. By meticulously scrutinizing patient outcomes and conducting a comprehensive analysis of safety aspects, this study aspires to offer enlightening revelations regarding the promise and practicality of pulsed RFNA as a therapeutic solution for tackling this intricate and tenacious condition. Methods This retrospective study included 24 patients who had undergone pulsed RFNA for recalcitrant plantar fasciitis between June 1, 2020, and June 1, 2022, at Hospital Pengajar Universiti Putra Malaysia (HPUPM), Hospital Universiti Teknologi Mara (UiTM), and Hospital Serdang. Patients were selected from the Orthopedic Clinics at HPUPM, Hospital UiTM, and Hospital Serdang and were screened according to the inclusion and exclusion criteria. Patient data was extracted from the hospital information system and electronic medical records. Pre-procedure and post-procedure assessments were conducted at one, three, and six months on the selected patients using the visual analog scale and American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scoring systems. All selected patient data was traced and tabulated accordingly. Results This study evaluates the effectiveness of pulsed RFNA in treating recalcitrant plantar fasciitis in 24 participants (39 feet). Results show a significant reduction in pain and improvement in functionality at one, three, and six months post-RFNA. Demographic factors (age, gender, and specific diagnosis) did not significantly impact outcomes. The study supports pulsed RFNA as an effective treatment for recalcitrant plantar fasciitis, emphasizing consistent benefits across various patient characteristics. Conclusion In conclusion, the study demonstrates the notable effectiveness of pulsed RFNA in improving pain reduction and functional outcomes for individuals with recalcitrant plantar fasciitis. The findings, consistent across various demographic factors, support pulsed RFNA as a promising and uniform treatment option for those who do not respond to conservative measures.
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Affiliation(s)
- Kumarendran Kanesen
- Department of Orthopedics and Traumatology, Hospital Sultan Abdul Aziz Shah/University Putra Malaysia, Serdang, MYS
| | - Mohd Shahril Jaafar
- Department of Orthopedics and Traumatology, Hospital Sultan Abdul Aziz Shah/University Putra Malaysia, Serdang, MYS
| | - Azammuddin Alias
- Department of Orthopedics and Traumatology, Hospital Sultan Abdul Aziz Shah/University Putra Malaysia, Serdang, MYS
| | - Ming Long Kam
- Department of Orthopedics, Hospital Sultan Idris Shah Serdang, Kajang, MYS
| | - Mohd Yusoff B Yahaya
- Department of Orthopedics and Traumatology, Universiti Teknologi MARA, Shah Alam, MYS
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Tas NP, Kaya O. Treatment of Plantar Fasciitis in Patients with Calcaneal Spurs: Radiofrequency Thermal Ablation or Extracorporeal Shock Wave Therapy? J Clin Med 2023; 12:6503. [PMID: 37892641 PMCID: PMC10607467 DOI: 10.3390/jcm12206503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES We aimed to compare the effectiveness of ESWT (Extracorporeal Shock Wave Therapy) and RFA (Radiofrequency Thermal Ablation) on pain, disability, and activity limitation in the treatment of plantar fasciitis in patients with calcaneal spurs. MATERIALS AND METHODS Patients who apply to Orthopedics and Traumatology and Physical Medicine and Rehabilitation departments with a complaint of heel pain are included in this retrospective study. We included patients diagnosed with calcaneal spurs who received treatment with ESWT (n = 80) and RFA (n = 79) between 1 August 2021 and 1 September 2022. All patients were evaluated using the Visual Analog Scale (VAS), Foot Function Index (FFI), and the Roles and Maudsley score (RM) before and after treatment. An evaluation was performed on average 6 months after treatment. RESULTS This study included 79 RFA patients (34 females and 45 males) with a mean age of 55.8 ± 9.6 years and 80 ESWT patients (20 females and 60 males) with a mean age of 49.1 ± 9.5 years. There was a significant decrease in VAS scores after treatment in both the RFA and ESWT groups (z: -4.98, z: -5.18, respectively, p < 0.001). The reductions in FFI pain, FFI activity restriction, FFI disability, and RM scores were significant in both groups, although the scores after treatment were lower in the RFA group. CONCLUSIONS This study demonstrates that ESWT and RFA significantly reduced pain, disability, and activity restriction in the treatment of plantar fasciitis in patients with calcaneal spurs. ESWT proved particularly effective in alleviating pain, whereas RFA had more pronounced effects on reducing disability and activity limitations. The choice of treatment should be based on the patient's specific complaints.
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Affiliation(s)
- Nevsun Pihtili Tas
- Department of Physical Medicine and Rehabilitation, Health Sciences University Elazig Fethi Sekin City Hospital, Elazıg 23280, Turkey
| | - Oğuz Kaya
- Department of Orthopedics and Traumatology, Elazig Fethi Sekin City Hospital, Elazıg 23280, Turkey;
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Tseng WC, Chen YC, Lee TM, Chen WS. Plantar Fasciitis: An Updated Review. J Med Ultrasound 2023; 31:268-274. [PMID: 38264606 PMCID: PMC10802877 DOI: 10.4103/jmu.jmu_2_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/14/2023] [Accepted: 04/10/2023] [Indexed: 01/25/2024] Open
Abstract
Plantar fasciitis (PF) is a common musculoskeletal disease. Histologic findings of patients with PF showed mainly chronic degenerative processes rather than inflammation. In addition to mechanical factors, such as repetitive stress and reduced ankle dorsiflexion, PF is also linked to rheumatologic diseases and genetic factors. Ultrasound is becoming a standard imaging technique for assessing PF. Major sonographic findings included increased plantar fascia thickness and hypoechoic plantar fascia. In addition to traditional B-mode ultrasound, sonoelastography can also be utilized to diagnose PF. Ultrasound can also be used to guide therapeutic interventions. Over 80% of patients with PF improved under nonsurgical treatment. Treatment options for PF include physical therapy, modalities (laser, therapeutic ultrasound), extracorporeal shock wave therapy (ESWT), injections, transcatheter arterial embolization, and surgery. For injections, corticosteroid was mostly used in the past but has been replaced gradually by other techniques such as platelet-rich plasma or dextrose prolotherapy. There is also more and more evidence about ESWT in treating PF. Surgery serves as an option for recalcitrant PF cases, and endoscopic fasciotomy seemed to have good outcomes. Ultrasound plays an important role in diagnosing of PF and evaluating the treatment effect, and the use of sonoelastography in addition to traditional B-mode ultrasound may help in the early detection of PF and assessment of the treatment effect.
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Affiliation(s)
- Wen-Che Tseng
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Yun-Chang Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsung-Min Lee
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Shiang Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan
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Kurtoglu A, Kochai A, Inanmaz ME, Sukur E, Keskin D, Türker M, Sen Z, Daldal I, Avan LY. Effectiveness of radiofrequency ablation for treatment of plantar fasciitis. Medicine (Baltimore) 2022; 101:e29142. [PMID: 35357356 PMCID: PMC11319323 DOI: 10.1097/md.0000000000029142] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/03/2022] [Indexed: 11/27/2022] Open
Abstract
ABSTRACT Plantar fasciitis is the most common cause of heel pain. Pain can be persistent in some patients and interrupt daily activities and sportive activities. There are a lot of treatment options available for plantar fasciitis. We hypothesized that patients with chronic persistent plantar fasciitis can be successfully treated with radiofrequency nerve ablation (RFNA).Two hundred sixty-one patients with plantar fasciitis (378 feet) treated with RFNA from February 2017 to January 2019 were retrospectively assessed. All the patients had plantar heel pain for at least 6months. Based on their body mass index (BMI), the enrolled patients were divided into obese (BMI ≥ 30kg/m2) and non-obese (BMI < 30kg/m2) groups. The patients were asked to complete a questionnaire just before and after the procedure and during the final follow-up. The BNS Radiofrequency Lesion Generator was used during a single session. The patients' information, including their visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) score, was assessed. During their final follow-up, the patients were asked to rate the success of their treatment by choosing one of the following options: completely successful, very successful, moderately successful, marginally successful, or not successful.The VAS and AOFAS scores of all the patients were evaluated pre-procedure, in the first month after procedure, and during the final follow-up (8-24 months). There was a statistically significant difference between the pre-procedure and postprocedure VAS scores (P < .001), there was no statistically significant difference between the VAS scores in the first month postprocedure and during the final follow-up.There was a statistically significant difference between the pre-procedure and postprocedure AOFAS scores (P < .001), there was no statistically significant difference between the AOFAS scores in the first month postprocedure and during the final follow-up.RFNA can be used as an alternative method to surgical procedures for treating plantar fasciitis because it is safe and effective. The advantages of RFNA are that patients can quickly return to their work and resume weight-bearing activities.
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Affiliation(s)
- Alper Kurtoglu
- Sakarya University Research and Training Hospital, Adapazari, Sakarya, Turkey,
| | - Alauddin Kochai
- Sakarya University Research and Training Hospital, Adapazari, Sakarya, Turkey,
| | | | - Erhan Sukur
- Sakarya University Research and Training Hospital, Adapazari, Sakarya, Turkey,
| | - Dogan Keskin
- Sakarya University Research and Training Hospital, Adapazari, Sakarya, Turkey,
| | - Mehmet Türker
- Sakarya University Research and Training Hospital, Adapazari, Sakarya, Turkey,
| | - Zafer Sen
- University of Health Sciences, Konya City Hospital Orthopedics and Traumatology, Turkey,
| | - Ismail Daldal
- Lokman Hekim Akay Hospital, Department of Orthopaedic and Traumatology, Ankara, Turkey.
| | - Laçin Yüksel Avan
- Sakarya University Research and Training Hospital, Adapazari, Sakarya, Turkey,
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Effects of intralesional pulsed radiofrequency treatment on pain in patients with calcaneal spur: results of 460 patients. BMC Musculoskelet Disord 2021; 22:1033. [PMID: 34893055 PMCID: PMC8665537 DOI: 10.1186/s12891-021-04926-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to investigate the efficacy of intralesional pulsed radiofrequency (RF) in the treatment of calcaneal spur and the results of patients who underwent single and double sessions of RF treatment. Methods The population of this retrospective study consisted of 460 patients who were diagnosed with calcaneal spur with clinical examination and direct radiography. The Wong-Baker Faces Pain Rating Scale and The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score were used to determine the pain status and functional capacities of the patients. Posttreatment evaluation was carried out on average in the 6th week. Results The study involved 460 patients, 76.9% of whom were female, with the average age of 50.8 ± 10.9 years in total. Of the patients 43% was given RF therapy in a single session, and 57% of them in double sessions. After the RF procedure, the number of patients whose pain decreased according to both AOFAS and Wong-Baker pain scoring systems increased statistically significantly (p < 0.001). There was a statistically significant increase in the AOFAS-pain scores and the total AOFAS scores and a significant decrease in the Wong Baker-pain scale after treatment. However, there was no significant change in treatment success with respect to the number of RF sessions. Although not statistically significant, the differences in the AOFAS-pain scores and in the total AOFAS scores were found to be higher in patients who underwent single session RF, while the difference in the Wong Baker-pain ranking was higher in patients who received double sessions RF. Conclusion Intralesional pulsed RF procedure can be preferred as a relatively less invasive method that does not have any serious complications in patients with persistent calcaneal spurs who do not respond to the use of oral anti-inflammatory drugs and shoe insoles, nor corticosteroid injection to the lesion area.
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7
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Beard NM. Nerve Ablation in the Foot and Ankle. Phys Med Rehabil Clin N Am 2021; 32:803-818. [PMID: 34593145 DOI: 10.1016/j.pmr.2021.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ablation therapies in the foot and ankle are accessible adjuncts to surgery and comprehensive pain management in recalcitrant pain syndromes. Techniques are best applied to individual patient anatomy with strong advantages in a working knowledge of neuromuscular real-time imaging with ultrasound. Interventionists face the unique challenge in this region of preserving balance and proprioception as well as intrinsic muscle function, while optimizing pain relief. A decision-making approach emphasizing selectivity by using regional and target-specific ablations is optimal. This article reviews basic technique, approaches, potential complications, and ultrasound anatomy for a practical introduction to ablation options in the foot and ankle.
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Affiliation(s)
- Nahum M Beard
- Faculty Campbell Clinic Sports Medicine Fellowship, Department of Orthopaedic Surgery and Rehabilitation, Department of Family Medicine, University of Tennessee Health Science Center, 1400 South Germantown Road, Germantown, TN 38138, USA.
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8
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Plantar Fasciitis: Distal Tarsal Tunnel (Baxter's Nerve) in the Athlete. OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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9
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Hasegawa M, Urits I, Orhurhu V, Orhurhu MS, Brinkman J, Giacomazzi S, Foster L, Manchikanti L, Kaye AD, Kaye RJ, Viswanath O. Current Concepts of Minimally Invasive Treatment Options for Plantar Fasciitis: a Comprehensive Review. Curr Pain Headache Rep 2020; 24:55. [PMID: 32785856 DOI: 10.1007/s11916-020-00883-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW Chronic foot pain constitutes a large portion of the chronic pain burden in the overall population. Plantar fasciitis is one of the most common and most easily identifiable causes of chronic foot pain. The syndrome has been estimated to cause 11 to 15% of foot pain visits, requiring professional care. Moreover, studies have suggested that 1 in 10 people will develop plantar fasciitis at some point in their life. Conservative management has been shown to be effective and considered first-line treatment. Minimally invasive treatment options are typically reserved for those who fail conservative management. With the advent of new techniques and improvements in current therapeutic options, there has been an expansion of available minimally invasive treatment options. The purpose of this review is to provide a comprehensive update on the current understanding of minimally invasive treatments of plantar fasciitis. RECENT FINDINGS This review shows that conservative management continues to be the first-line therapy, whereas other treatment options were those who failed conservative management using modern techniques that have shown improving effectiveness, with successful restoration of patient functionality, recovery, and satisfaction. However, a multitude of these minimally invasive treatment options are evolving. CONCLUSION While conservative management continues to be the mainstay of treatment for plantar fasciitis, multiple minimally invasive treatment options are emerging with potential effectiveness in reducing pain and improving the function.
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Affiliation(s)
- Morgan Hasegawa
- Creighton University School of Medicine at Regional Campus St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
| | - Vwaire Orhurhu
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mariam Salisu Orhurhu
- Department of Anesthesia, Critical Care, and Pain Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Joseph Brinkman
- Creighton University School of Medicine at Regional Campus St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Stephen Giacomazzi
- Creighton University School of Medicine at Regional Campus St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Lukas Foster
- Creighton University School of Medicine at Regional Campus St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | | | - Alan D Kaye
- Louisiana State University Health Science Center, Shreveport, LA, USA
| | - Rachel J Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Omar Viswanath
- Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA.,Valley Anesthesiology and Pain Consultants, Phoenix, AZ, USA.,Department of Anesthesiology, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA.,Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
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10
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A Systematic Review of Radiofrequency Treatment of the Ankle for the Management of Chronic Foot and Ankle Pain. Curr Pain Headache Rep 2019; 23:4. [PMID: 30661127 DOI: 10.1007/s11916-019-0745-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic pain of the lower extremity remains challenging to manage. Radiofrequency treatment applies heat to nerve fibers with the goal of mitigating chronic pain conditions. The clinical efficacy has not yet been adequately established for pathologies of the ankle and foot. In this review paper, we report the use and efficacy of radiofrequency treatment applied to foot and ankle pain. RECENT FINDINGS PubMed and the Cochrane Controlled Trials Register were searched (final search 30 March 2018) using the MeSH terms "radiofrequency ablation," "neurolysis," "radiofrequency therapy," "pain syndrome," "analgesia," "plantar heel pain," "plantar fascitis," and "chronic pain" in the English literature. Of the 23 papers screened, 18 were further investigated for relevance. Our final search methodology yielded 15 studies that investigated the use of radiofrequency treatment at the ankle. Of these 15 studies, there were three randomized control trials, four prospective studies, three retrospective studies, and five case reports. The quality of selected publications was assessed using the Cochrane risk of bias instrument. The evidence from our studies suggests that radiofrequency treatment can be used safely for the management foot and ankle pain. The technique (continuous vs pulsatile), temperature, location of treatment, and duration of administration need more thorough evaluation. Randomized control trials are needed to establish the efficacy and safety profile of radiofrequency ablation and its long-term benefits in patients with chronic pain of the foot and ankle. CONCLUSION The evidence from our studies suggests that radiofrequency treatment can be used safely for the management foot and ankle pain. The technique (continuous vs pulsatile), temperature, location of treatment, and duration of administration need more thorough evaluation. Randomized control trials are needed to establish the efficacy and safety profile of radiofrequency ablation and its long-term benefits in patients with chronic pain of the foot and ankle.
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Abstract
This article is a comprehensive review of the current utilizations of ultrasound in the treatment of orthopedic conditions of the foot and ankle. It reviews the diagnostic and interventional applications to commonly encountered lower-extremity ailments, including plantar fasciosis, tendinosis, and peripheral nerve disorders. It also outlines minimally invasive ultrasound-guided procedures and emerging therapies as alternatives to current treatments. These emerging therapies can be used to assist surgeons and provide options for patients needing intervention. Techniques such as hydrodissection, injection, aspiration, tenotomy, and fasciotomy are discussed, giving readers insight into different treatment modalities and options to help manage their patients.
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Affiliation(s)
- Nahum Michael Beard
- Department of Family Medicine, University of Tennessee Health Science Center, Saint Francis Family Medicine, 1301 Primacy Parkway, Memphis, TN 38119, USA; Department of Orthopaedic Surgery and Biomedical Engineering, 1211 Union Avenue Suite 520, Memphis, TN 38104.
| | - Robert Patrick Gousse
- Department of Orthopaedic Surgery and Biomedical Engineering, 1211 Union Avenue Suite 520, Memphis, TN 38104
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Ozan F, Koyuncu Ş, Gürbüz K, Öncel ES, Altay T. Radiofrequency Thermal Lesioning and Extracorporeal Shockwave Therapy: A Comparison of Two Methods in the Treatment of Plantar Fasciitis. Foot Ankle Spec 2017; 10:204-209. [PMID: 27807291 DOI: 10.1177/1938640016675408] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED We compared the results of radiofrequency thermal lesioning (RTL) and extracorporeal shockwave therapy (ESWT) in patients with chronic plantar fasciitis. This prospective study included 56 patients diagnosed with plantar fasciitis who had complaints for ≥6 months: 40 (group 1) underwent ESWT and 16 (group 2) underwent RTL. The presence of calcaneal spurs was investigated with imaging studies. All patients were followed up clinically at baseline and 1, 3, and 6 months after treatment. Clinical evaluations were performed by the visual analog scale (VAS) and the modified Roles-Maudsley (RM) scoring system. There was no significant difference in the age, sex, body mass index, and side of involvement between the groups (all P > .05). Radiographic evaluation showed calcaneal spurs in 22 patients (55%) in group 1 and 7 patients (43%) in group 2. There was no significant difference in the baseline and posttreatment values between the groups; however, group 2 had significantly different RM values at 1 month than group 1 ( P < .05). In both groups, the VAS scores significantly decreased at 1, 3, and 6 months after treatment ( P < .05). The RM scores at 1, 3, and 6 months after treatment significantly decreased in both groups, except for the RM values at 1 month after treatment in group 1 ( P < .05). Our study results suggest that RTL and ESWT are safe and effective treatments in patients with chronic plantar fasciitis. LEVELS OF EVIDENCE Level II: Therapeutic study.
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Affiliation(s)
- Fırat Ozan
- Department of Orthopedics and Traumatology, Kayseri Training and Research Hospital, Kayseri, Turkey (FO, KG, ESÖ).,Department of Orthopedics and Traumatology, Bayburt State Hospital, Bayburt, Turkey (ŞK).,Department of Orthopedics and Traumatology, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey (TA)
| | - Şemmi Koyuncu
- Department of Orthopedics and Traumatology, Kayseri Training and Research Hospital, Kayseri, Turkey (FO, KG, ESÖ).,Department of Orthopedics and Traumatology, Bayburt State Hospital, Bayburt, Turkey (ŞK).,Department of Orthopedics and Traumatology, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey (TA)
| | - Kaan Gürbüz
- Department of Orthopedics and Traumatology, Kayseri Training and Research Hospital, Kayseri, Turkey (FO, KG, ESÖ).,Department of Orthopedics and Traumatology, Bayburt State Hospital, Bayburt, Turkey (ŞK).,Department of Orthopedics and Traumatology, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey (TA)
| | - Eyyüp Sabri Öncel
- Department of Orthopedics and Traumatology, Kayseri Training and Research Hospital, Kayseri, Turkey (FO, KG, ESÖ).,Department of Orthopedics and Traumatology, Bayburt State Hospital, Bayburt, Turkey (ŞK).,Department of Orthopedics and Traumatology, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey (TA)
| | - Taşkın Altay
- Department of Orthopedics and Traumatology, Kayseri Training and Research Hospital, Kayseri, Turkey (FO, KG, ESÖ).,Department of Orthopedics and Traumatology, Bayburt State Hospital, Bayburt, Turkey (ŞK).,Department of Orthopedics and Traumatology, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey (TA)
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Wu YT, Chang CY, Chou YC, Yeh CC, Li TY, Chu HY, Chen LC. Ultrasound-Guided Pulsed Radiofrequency Stimulation of Posterior Tibial Nerve: A Potential Novel Intervention for Recalcitrant Plantar Fasciitis. Arch Phys Med Rehabil 2017; 98:964-970. [DOI: 10.1016/j.apmr.2017.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/10/2017] [Accepted: 01/11/2017] [Indexed: 11/25/2022]
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Arslan A, Koca TT, Utkan A, Sevimli R, Akel İ. Treatment of Chronic Plantar Heel Pain With Radiofrequency Neural Ablation of the First Branch of the Lateral Plantar Nerve and Medial Calcaneal Nerve Branches. J Foot Ankle Surg 2016; 55:767-71. [PMID: 27073185 DOI: 10.1053/j.jfas.2016.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Indexed: 02/03/2023]
Abstract
From March 2012 to February 2013, 37 patients experiencing plantar heel pain for ≥6 months despite treatment with physical therapy and other conservative treatment modalities were followed up. If neurogenic heel pain originating from the first branch of the lateral plantar nerve was present, with or without the medial calcaneal nerve, diagnostic nerve blocks to these nerves were performed for confirmation. If the pain was determined to be of neurogenic origin, radiofrequency neural ablation (RFNA) was applied to the corresponding sensory nerve endings. Pain was evaluated using the visual analog scale, and patients were followed for at least one year. A total of 41 feet from 37 patients (30 [81.1%] females, 7 [18.9%] males; mean age, 50.7 ± 1.6 years; mean body mass index, 30.6 ± 0.7 kg/m(2)) were included. The mean visual analog scale scores improved significantly from 1 to 6 to 12 months after the procedure relative to before the procedure, with 88% of all patients rating the treatment as either very successful or successful at 12 months postoperatively. RFNA applied to both the first branch of the lateral plantar nerve and the medial calcaneal nerve sensory branches (16 [39%] feet) and only the first branch of the lateral plantar nerve sensory branches (25 [61%] feet) showed similarly high levels of success. Of the 41 feet, 28 [68.3%] had received extracorporeal shockwave therapy, 35 [85.4%] had received steroid injections, and 22 [53.7%] had received both extracorporeal shockwave therapy and steroid injections before RFNA as an index procedure. All were unresponsive to these previous treatments. In contrast, almost all (88%) were treated successfully with RFNA. Despite a high incidence of neurologic variations, with a precise diagnosis and good application of the technique using the painful points, chronic plantar heel pain can be treated successfully with RFNA.
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Affiliation(s)
- Aydın Arslan
- Orthopaedic Surgeon, Department of Orthopaedics, State Hospital, Malatya, Turkey.
| | - Tuba Tulay Koca
- Physical Therapy and Rehabilitation Specialist, Department of Physical Therapy and Rehabilitation, State Hospital, Malatya, Turkey
| | - Ali Utkan
- Orthopaedic Surgeon, Department of Orthopaedics, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Resit Sevimli
- Orthopaedic Surgeon and Assistant Professor, Department of Orthopaedics, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey
| | - İbrahim Akel
- Orthopaedic Surgeon and Associate Professor, Department of Orthopaedics, Kent Hospital, İzmir, Turkey
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15
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Kulig K, Noceti-DeWit LM, Reischl SF, Landel RF. Physical therapists' role in prevention and management of patellar tendinopathy injuries in youth, collegiate, and middle-aged indoor volleyball athletes. Braz J Phys Ther 2015; 19:410-20. [PMID: 26537811 PMCID: PMC4647152 DOI: 10.1590/bjpt-rbf.2014.0126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 06/26/2015] [Indexed: 11/24/2022] Open
Abstract
Patellar tendinopathy is highly prevalent in all ages and skill levels of volleyball
athletes. To illustrate this, we discuss the clinical, biomechanical, and ultrasound
imaging presentation and the intervention strategies of three volleyball athletes at
different stages of their athletic career: youth, middle-aged, and collegiate. We
present our examination strategies and interpret the data collected, including visual
movement analysis and dynamics, relating these findings to the probable causes of
their pain and dysfunction. Using the framework of the EdUReP concept, incorporating
Education, Unloading, Reloading, and Prevention, we propose intervention strategies
that target each athlete's specific issues in terms of education, rehabilitation,
training, and return to sport. This framework can be generalized to manage patellar
tendinopathy in other sports requiring jumping, from youth to middle age, and from
recreational to elite competitive levels.
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Affiliation(s)
| | | | | | - Rob F Landel
- University of Southern California, Los Angeles, CA, USA
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16
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Gerdesmeyer L, Schaden W, Besch L, Stukenberg M, Doerner L, Muehlhofer H, Toepfer A. Osteogenetic effect of extracorporeal shock waves in human. Int J Surg 2015; 24:115-9. [PMID: 26455534 DOI: 10.1016/j.ijsu.2015.09.068] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/18/2015] [Accepted: 09/13/2015] [Indexed: 11/26/2022]
Affiliation(s)
- L Gerdesmeyer
- Dept Orthopaedic Surgery and Traumatology, University Schleswig Holstein, Campus Kiel, Arnold Heller Strasse, 24105 Kiel, Germany; Dept for Orthopedics, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675 Munich, Germany.
| | - W Schaden
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstrasse 13, 1200 Vienna, Austria
| | - L Besch
- Dept Orthopaedic Surgery and Traumatology, University Schleswig Holstein, Campus Kiel, Arnold Heller Strasse, 24105 Kiel, Germany
| | - M Stukenberg
- Dept Orthopaedic Surgery and Traumatology, University Schleswig Holstein, Campus Kiel, Arnold Heller Strasse, 24105 Kiel, Germany
| | - L Doerner
- Dept Orthopaedic Surgery and Traumatology, University Schleswig Holstein, Campus Kiel, Arnold Heller Strasse, 24105 Kiel, Germany
| | - H Muehlhofer
- Dept for Orthopedics, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675 Munich, Germany
| | - A Toepfer
- Dept for Orthopedics, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675 Munich, Germany
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