A 12-Year Long-Term Retrospective Analysis of the Use of Radiofrequency Nerve Ablation for the Treatment of Neurogenic Heel Pain

Abstract

The authors discuss their rationale for the use of radiofrequency nerve ablation (RFNA) in the treatment of chronic neurogenic heel pain. Patients treated for plantar fasciitis who fail to improve after conservative and/ or surgical treatment should be reevaluated for a coexistent nerve entrapment. The results of a retrospective study of 82 patients who have undergone RFNA are presented. The patients were followed at 5, 10, and 12 years after the procedure. An evaluation of medical records was performed as a means of inclusion in this study. A standardized telephone interview was then done, and subjectively scored responses of the patients were recorded and analyzed. Of the patients, 89% reported no recurrence of pain after 5, 10, and 12 years postoperatively. The procedure is relatively easy to perform and involves inserting a 22-gauge cannula with an electrode into the areas of pain. This is done under general anesthesia. It takes approximately 15 to 20 minutes per heel to perform, depending on how many sites of tenderness have been identified. The patient is discharged with a minimal bandage and returns to shoe gear immediately following the procedure. The success rate with RFNA appears to be quite high with fewer associated risks and less post-operative morbidity.

Anatomic Delineation of Tarsal Tunnel Innervation via Ultrasonography

“…In cadaver studies of anatomy, various authors have described the variable anatomy of the tibial nerve and its terminal branches in terms of the location of its bifurcation with respect to the flexor retinaculum . The main variations are the bifurcation of the tibial nerve into the medial and lateral plantar nerves with respect to the retinaculum, bifurcation of the medial calcaneal branch, and bifurcation of the first calcaneal branch.…”

Outcome of Corticosteroid Injections, Extracorporeal Shock Wave Therapy, and Radiofrequency Thermal Lesioning for Chronic Plantar Fasciitis

“…Sollitto et al 27 performed RTL for resistant PF and reported that 92% of the patients experienced a complete resolution of the symptoms. Cozzarelli et al 9 reported a success rate of 89% for radiofrequency nerve ablation (RFNA) in the treatment of chronic neurogenic heel pain at the 5-, 10-, and 12-year follow-ups. Similarly, Cione et al 8 reported a 93.3% success rate of RTL in patients with plantar heel pain with a neurological origin, such as medial calcaneal nerve entrapment or heel neuroma.…”

“…Chronic heel pain associated with plantar fasciitis (PF) is one of the most common clinical entities encountered by foot and ankle specialists and affects adults of all ages with either an active or sedentary lifestyle. 9 Within their lifetime, 10% of the general population is expected to present to orthopedic surgeons with heel pain due to degenerative changes in the plantar fascia. 19,20 PF results from the cumulative effect of recurrent microinjuries and chronic damage in the plantar aponeurosis at the insertion of the plantar fascia on the medial process of the calcaneal tuberosity.…”

Compressive neuropathy of the first branch of the lateral plantar nerve: a study by magnetic resonance imaging

“…Chronic plantar fasciitis and local varicosities represented the findings most frequently associated with entrapment of the abductor digiti quinti nerve. Initially, heel pain should be treated with conservative measures, including the use of a nocturnal orthosis, therapeutic footwear, physical therapy, anti-inflammatory drugs and corticoid infiltration ( 16 , 34 , 35 ) .…”

“…As the pain becomes chronic, over a period longer than six month and without any improvement with the conservative treatment, the hypothesis of compression of the first branch of the lateral plantar nerve should be considered. In such cases, the patients may benefit from surgical decompression of the region ( 16 , 35 - 37 ) by endoscopic approach ( 16 , 36 ) , radiofrequency ablation techniques ( 34 ) or open surgery.…”