Radiofrequency microtenotomy vs plantar fasciotomy for plantar fasciitis

NewsBot · Dec 16, 2015

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Radiofrequency microtenotomy is as effective as plantar fasciotomy in the treatment of recalcitrant plantar fasciitis
Andrew Chia Chen Chou et al
Foot and Ankle Surgery; Available online 15 December 2015

Background
Radiofrequency microtenotomy (RM) is effective for treating plantar fasciitis. No studies have compared it to the plantar fasciotomy (PF). We hypothesized that RM is equally effective and provides no additional benefit when performed with PF.

Methods
Between 2007 and 2014, all patients who underwent either or both procedures concurrently at our institution were analyzed. Data collected included demographics, SF-36 Health Survey, AOFAS Ankle-Hindfoot Scale, and two questions regarding satisfaction and expectations, all of which were assessed pre-operatively and post-operatively at 6-months and 1-year. ANOVA with Bonferroni correction was used to compare scores at each interval. Logistic regression was used to identify pre-operative factors that predicted for satisfaction and expectations.

Results
There were no differences in patient outcomes. No pre-operative factors predicted for satisfaction and expectations.

Conclusions
RM is as effective as PF in the treatment of plantar fasciitis. Patients who underwent both procedures experienced no benefit and a higher rate of complications.
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Admin2 · Dec 16, 2015

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Recalcitrant Plantar Fasciitis: Is Fasciotomy Ever Necessary?

NewsBot · Nov 29, 2017

Endoscopic Plantar Fasciotomy vs Open Radiofrequency Microtenotomy for Recalcitrant Plantar Fasciitis.
Wang W et al
Foot Ankle Int. 2017 Nov 1:1071100717732763. doi: 10.1177/1071100717732763.

BACKGROUND:
Although usually self-limiting, around 10% of patients develop recalcitrant plantar fasciitis despite conservative treatment. In such cases, operative intervention can be offered. Traditionally, plantar fasciotomy has been the treatment of choice, but recently, there has been a push for more minimally invasive approaches. Radiofrequency microtenotomy has also been increasingly used as a treatment option. In this study, we compare the outcomes of endoscopic plantar fasciotomy and open radiofrequency microtenotomy.
METHODS:
Patients treated in our institution with either procedure between 2007 and 2015 were included and interviewed at baseline and 3 months, 6 months, and 12 months postoperatively using the American Orthopaedic Foot and Ankle Society (AOFAS) and 36-item Medical Outcomes Short Form (SF-36) questionnaires. They were asked questions to evaluate their expectation and satisfaction postoperatively. Demographic and clinicopathological data were prospectively collected from clinical charts and electronic records.
RESULTS:
There was no difference in either treatment arms preoperatively and an overall improvement in all functional outcomes postoperatively. However, patients who had endoscopic plantar fasciotomy fared better at 3 months compared to patients who underwent open microtenotomy with the visual analog score component of the AOFAS hindfoot score (HINDVAS) and the social functioning and role-functioning-emotional reaching statistical significance ( P = .027, P = .03, and P = .03, respectively). There was no difference in functional outcomes at 6 or 12 months postoperatively.
CONCLUSION:
Endoscopic plantar fasciotomy was associated with an earlier improvement in functional outcome in our study. However, both treatments had equivalent outcomes at 1-year follow-up, suggesting that either method is reasonable in the treatment of chronic plantar fasciitis.
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NewsBot · Jun 20, 2021

Development of Multiple Epidermal Inclusion Cysts after Radiofrequency Microtenotomy for Plantar Fasciitis: A Case Report
Jennifer Skolnik, DPM et al
JFAS : May 20, 2021

Epidermal inclusion cysts are slowly developing intradermal lesions which form after the implantation of epidermal tissue into the dermal tissue. Epidermal cysts occur infrequently in the foot, but can occur after traumatic episodes, including surgically induced trauma. Epidermal inclusion cysts have been described as a complication of minimally invasive foot and ankle surgery; however, they have been described infrequently as a complication of radiofrequency microtenotomy. To our knowledge, only one other case study exists discussing the development of a singular epidermal cyst after undergoing radiofrequency microtenotomy. Therefore, the purpose of the present case report was to discuss a case of the development of multiple epidermal inclusion cysts of the plantar heel after radiofrequency microtenotomy for treatment of plantar fasciitis. After undergoing radiofrequency coblation in November 2017, the patient developed multiple plantar heel cysts. She went on to have them surgically removed in February 2018 and again in June 2018. By the time of presentation to our office in October 2018, multiple cysts were still present to her heel despite two surgical excisions. Seventeen months after surgical excision in February 2019, the patient remained cyst-free.
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NewsBot · Oct 4, 2021

Radiofrequency Microtenotomy for Plantar Fasciitis: A Systematic Review and Meta-analysis
JessicaThor et al
The Foot; 25 September 2021, 101869

Highlights
•There is fair evidence (grade B) to support radiofrequency microtenotomy for plantar Fasciitis.
•Meta-analysis showed radiofrequency microtenotomy resulted in a mean increase in AOFAS score of 40.9.
•There was no good (grade A) evidence as there was a lack of high quality level I randomised controlled trials in the literature.
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Background
Currently, there is limited evidence on outcomes for plantar fascia radiofrequency microtenotomy. We aim to provide an evidence-based systematic review and meta-analysis for outcomes of radiofrequency microtenotomy for the treatment of plantar fasciitis.

Methods
A comprehensive evidence-based literature review of PubMed and Cochrane Databases was conducted in March 2019, which identified 11 relevant articles assessing the efficacy of plantar fascia radiofrequency microtenotomy. The studies were then assigned to a level of evidence (I-IV). Individual studies were reviewed to provide a grade of recommendation (A-C, I) according to the Wright classification in support of or against endoscopic plantar fascia release. Meta-analysis was performed for 7 of the studies that measured AOFAS scores.

Results
Based on the results of this evidence-based review, there was fair (grade B) evidence to support plantar fascia radiofrequency microtenotomy. There was a statistically significant mean increase of 40.9 in AOFAS scores post procedure.

Conclusion
There was fair (grade B) evidence to recommend radiofrequency microtenotomy for plantar fasciitis. There is a need for more high quality level I randomized controlled trials with validated outcome measures to allow for stronger recommendations to be made.
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NewsBot · Jun 2, 2022

Radiofrequency Plantar Fascia Coblation With and Without Gastrocnemius Recession in the Management of Recalcitrant Plantar Fasciitis
Don Thong Siang Koh et al
Foot Ankle Int. 2022 Jun 2

Background: Plantar fasciitis is the most common cause of plantar heel pain. Although most are self-limiting, recalcitrant conditions can be debilitating, significantly reducing patient's quality of life. A myriad of surgical procedures are available for the treatment of recalcitrant plantar fasciitis (RPF) with little consensus on best practice. This purpose of this study was to assess the efficacy of radiofrequency coblation with and without gastrocnemius release on the surgical management of RPF.

Methods: Between June 2013 and June 2019, a total of 128 patients with RPF and tight gastrocnemius were treated surgically. Presence of tight gastrocnemius was assessed clinically by a positive Silfverskiold test. Group A (n = 73) consisted of patients who underwent radiofrequency coblation alone; group B (n = 55) consisted of patients who underwent radiofrequency coblation and endoscopic gastrocnemius recession. The primary outcome measure was visual analog scale (VAS) score. Secondary outcome measures included (1) American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score; (2) physical (PCS) and mental component summaries (MCS) of the 36-Item Short Form Health Survey; (3) overall assessment of improvement, expectation fulfilment, and satisfaction; and (4) complication rates.

Results: Both groups reported significant improvement in VAS, AOFAS, and PCS scores postoperatively at 6 and 24 months. Group B (radiofrequency coblation with gastrocnemius recession) was associated with better VAS at both 6 months (3.0 ± 2.9 vs 1.7 ± 2.6, P < .05) and 24 months postoperatively (1.9 ± 3.1 vs 0.8 ± 2.0, P < .05) compared with group A (radiofrequency coblation without gastrocnemius recession). At 24 months postoperatively, no differences were found in AOFAS, PCS, MCS scores, expectation fulfilment, or overall satisfaction. No wound complications were reported in either group. One patient (group B) has persistent symptoms consistent with tarsal tunnel syndrome.

Conclusion: In this retrospective cohort comparative study, treatment of RPF with radiofrequency coblation alone was associated with slightly inferior results than radiofrequency coblation combined with endoscopic gastrocnemius recession in terms of pain relief without an increase in complication rates. However, at 2 years, we did not find a significant difference in other measures of outcome.
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