Local Percutaneous Radiofrequency for Chronic Plantar Fasciitis

Abstract

Plantar fasciitis is the most common cause of heel pain. It accounts for 80% of the cases and has an estimated prevalence rate of up to 7% in the general population, with bilateral involvement in 20% to 30% of those patients. This condition affects people of working age, thereby limiting and diminishing their quality of life. There are a wide range of treatment options for the management of plantar fasciitis that include both conservative and surgical treatments. Although surgical treatment based on partial or total plantar fascia release has success rates of some 70% to 90%, it is not free of complications. These complications, soft-tissue healing problems, superficial infection, or longitudinal arch collapse in cases of a greater than 40% release of the fascia. Bipolar radiofrequency appears to be a safe procedure for refractory plantar fasciitis that can provide outcomes equivalent to open plantar fascia release with less morbidity. The purpose of this article is to describe the local percutaneous radiofrequency technique for patients with chronic, recalcitrant plantar fasciitis.

Technique Video

Video 1

The patient is positioned supine with the ankle draped and hanging freely over the edge of the table. With the ankle in dorsiflexion, the painful heel area is tested and outlined with a sterile marker. The points where radiofrequency will be applied are also drawn inside the painful area, with a distance of 5 mm between them. The calcaneal branch of the posterior tibial nerve is blocked under local anesthesia with mepivacaine 1%, 2 cm distal to the tip of the medial malleolus (ultrasound guidance can be used). The radiofrequency skin entrance points are punctured with a 1- to 1.5-mm Kirschner wire. The TOPAZ microdebrider is connected to the console and attached to a sterile saline solution drip, set at a drip rate of 1 drop every 2 seconds (the console must be set in position 4). Two radiofrequency impulses are delivered sequentially through each previously created percutaneous microincision (ultrasound guidance can be used). Postoperatively, a soft ankle bandage is applied and weight bearing as tolerated is allowed 2 days after the procedure.