Effect of Radiofrequency Treatment in Plantar Fasciitis Patients

Chronic plantar fasciitis is the most common cause of chronic heel pain in adults. Typically, patients describe a throbbing pain localized around the origin of the plantar fascia on the calcaneus. This pain is often most severe when taking the first steps in the morning or rising after sitting. It typically improves with activity but worsens with prolonged activity. The primary aim of heel spur treatment is to alleviate pain and restore function. Surgical interventions are recommended for chronic plantar heel pain resistant to conservative options. However, surgery may be associated with prolonged recovery, and in one study, superiority over conservative treatment was not demonstrated. Radiofrequency has been shown to be an effective treatment method for chronic plantar heel pain in many randomized and non-randomized studies. In many studies, most of these procedures are applied blindly based on anatomical landmarks, with attention drawn in many studies to applications targeting the terminal branches of the posterior tibial nerve or the spur region. Only a few studies have been performed using fluoroscopy and ultrasound guidance. Ultrasound guidance offers several advantages over fluoroscopy and blind landmark techniques, especially in interventional procedures targeting neural and soft tissues. These advantages include the ability to visualize vascular and neural structures, very low risk of vascular-neural injury, absence of radiation exposure, and superiority in cases of anatomical variation. However, a common point in many studies related to plantar fasciitis is that applications are either directed to the spur area or to neural structures leading to the heel region. In this study, we aim to compare the effects of radiofrequency modalities applied to the posterior tibial nerve and/or calcaneal spur area under ultrasound guidance on patient satisfaction, pain scores, and patient functionality in cases of chronic plantar fasciitis (heel spur).

Inclusion criteria

• 18-65 years old,
• Heel pain for at least 6 months and a diagnosis of plantar fasciitis confirmed by direct radiography and physical examination,
• Visual analog scale is 4 or more
• No response to conservative treatment (medical and physical medicine modalities)

Exclusion criteria

• History of trauma or calcaneus fracture,
• Osteoarthritis, Diabetes mellitus, chronic heart disease
• Presence of pregnancy,
• Pain due to peripheral neuropathy or ischemia
• Inability to tolerate injections in the heel area,
• Allergy to local anesthetics or steroids,
• Presence of an open wound on the side of the foot that the injection will be performed
• Local or systemic infection at the time of the procedure
• Previous steroid injection, radiofrequency application or ESWT (electroshock wave) treatment into the heel
• History of surgical intervention to the heel
• Presence of any functional limitation in the affected foot
• Presence of neurological, hepatic and/or metabolic diseases; dermatological infections, seronegative spondyloarthropathy, bleeding diathesis
• Failure to discontinue anticoagulant or antiaggregant within the specified periods
• Absence of follow-up throughout the study.