Radiofrequency microtenotomy for plantar fasciitis: A level II study

Plantar fasciitis is one of the most common causes of plantar heel pain and can become a frustrating and debilitating chronic condition. Treatment is largely non-operative with 90–95% of patients experiencing resolution of symptoms within 12–18 months. Treatment modalities that have been advocated include rest, stretching, nonsteroidal anti-inflammatory medication, manual therapy, heel pads, orthotics, taping, night splints, extracorporeal shock wave therapy, steroid injections and platelet-rich plasma injections.

In recalcitrant cases surgery may be required, with postoperative clinical improvement expected in most cases. Minimally invasive endoscopic plantar fascia release seemed to show good outcomes however grade of recommendation is poor (grade C), with complications of postoperative pain and paraesthesia reported from this treatment. The treatment modality of radiofrequency microtenotomy has shown promise as a less invasive and effective treatment for chronic plantar fasciitis. Microfrequency radiotenotomy can be done via various methods, with different surgeons performing it differently.

In general, the plantar fascia is accessed either via an incision over the heel or through percutaneous methods. Prior to surgery, patients may be first asked to identify the areas of maximal tenderness and they are marked. Following which, some surgeons have also described a use of a grid like pattern marking as well. A radiofrequency microtenotomy probe is then inserted and applied to the plantar fascia in fixed, grid like pattern.

Currently, there is limited evidence on outcomes for plantar fascia radiofrequency microtenotomy. An evidence-based systematic review and meta-analysis for outcomes of radiofrequency microtenotomy for the treatment of plantar fasciitis was conducted by J. Thor et al.

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.

Studies detailing the outcomes using radiofrequency microtenotomy as treatment for plantar fasciitis were included in this analysis. Radiofrequency thermal lesioning was also included in the analysis as it was considered a form of radiofrequency microtenotomy.

Non-English publications, pathology not related to plantar fasciitis, treatments other than radiofrequency microtenotomy and thermal lesioning, review articles, expert opinion and case studies were excluded.

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.

Grades of recommendation for summaries or reviews of orthopaedic surgical studies: Grade Description

A - Good evidence (level-I studies with consistent findings) for or against recommending intervention.

B - Fair evidence (level-II or III studies with consistent findings) for or against recommending intervention.

C - Conflicting or poor-quality evidence (level-IV or V studies) not allowing a recommendation for or against intervention.

I - There is insufficient or conflicting evidence not allowing a recommendation for or against recommending intervention.

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.

The authors concluded that 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.

Key Words: Plantar fasciitis, Radiofrequency, Microtenotomy, Review

Further reading:

Radiofrequency microtenotomy for plantar fasciitis: A systematic review and meta-analysis

Jessica Thor, David Weijia Mao, Darshana Chandrakumara, Qishi Zheng, Tae Wook Yoo, Charles Kon Kam King.

The Foot 50 (2022) 101869

https://doi.org/10.1016/j.foot.2021.101869