Effect of Radiofrequency Treatment in Plantar Fasciitis Patients

Fasciitis, Plantar Clinical Trial

Official title:

Effect of Radiofrequency Treatments on Foot Functionality Index, Patient Satisfaction and Pain Scores in Plantar Fasciitis Patients

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT06426667
• Other study ID #: 2024/202
• Status: Recruiting
• Start date: April 15, 2024
• Est. completion date: July 30, 2024

Study information

• Verified date: May 2024
• Source: Ankara University
• Contact: Hanzade A Unal, MD
• Phone: +905057179039
• Email: hanzadeunal[@]windowslive.com
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

In adults, chronic plantar fasciitis stands as the predominant cause of persistent heel discomfort.Usually, individuals depict a pulsating pain concentrated around the point of origin of the plantar fascia on the calcaneus. Numerous randomized and non-randomized studies have demonstrated the effectiveness of radiofrequency as a treatment modality for chronic plantar heel pain.In this study, our objective is to assess the impact of radiofrequency modalities applied to the posterior tibial nerve and/or the calcaneal spur area, guided by ultrasound, on patient satisfaction, pain scores, and functional improvement in individuals with chronic plantar fasciitis

Description:

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).

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 108
• Est. completion date: July 30, 2024
• Est. primary completion date: July 30, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 65 Years

Eligibility

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.

Related Conditions & MeSH terms

• Fasciitis
• Fasciitis, Plantar

Intervention

Procedure:
• posterior tibial nerve radiofrequency
pulse radiofrequency at 45 V for 300 seconds at 42 degrees Celsius is applied to the posterior tibial nerve area. During the procedure, the temperature at the electrode tip is kept below 42°C. Following negative aspiration (in the absence of blood), 2 cc of 1% lidocaine + 4 mg dexamethasone is applied to the same area.
• plantar fasciitis radiofrequency
the spur area on the calcaneal bone is identified, and sensory and motor stimulations are applied using the RF cannula. If no sensory or motor response is elicited in the area, conventional radiofrequency at 45 V for 60 seconds at 80 degrees Celsius is applied to the spur area after confirming the placement of the RF cannula.

Locations

Country	Name	City	State
Turkey	Ankara University	Ankara

Sponsors (1)

Lead Sponsor	Collaborator
Ankara University

Country where clinical trial is conducted

Turkey, 

References & Publications (4)

Latt LD, Jaffe DE, Tang Y, Taljanovic MS. Evaluation and Treatment of Chronic Plantar Fasciitis. Foot Ankle Orthop. 2020 Feb 13;5(1):2473011419896763. doi: 10.1177/2473011419896763. eCollection 2020 Jan. — View Citation

Li X, Zhang L, Gu S, Sun J, Qin Z, Yue J, Zhong Y, Ding N, Gao R. Comparative effectiveness of extracorporeal shock wave, ultrasound, low-level laser therapy, noninvasive interactive neurostimulation, and pulsed radiofrequency treatment for treating plantar fasciitis: A systematic review and network meta-analysis. Medicine (Baltimore). 2018 Oct;97(43):e12819. doi: 10.1097/MD.0000000000012819. — View Citation

Orhurhu V, Urits I, Orman S, Viswanath O, Abd-Elsayed A. A Systematic Review of Radiofrequency Treatment of the Ankle for the Management of Chronic Foot and Ankle Pain. Curr Pain Headache Rep. 2019 Jan 19;23(1):4. doi: 10.1007/s11916-019-0745-5. — View Citation

Wu YT, Chang CY, Chou YC, Yeh CC, Li TY, Chu HY, Chen LC. Ultrasound-Guided Pulsed Radiofrequency Stimulation of Posterior Tibial Nerve: A Potential Novel Intervention for Recalcitrant Plantar Fasciitis. Arch Phys Med Rehabil. 2017 May;98(5):964-970. doi: 10.1016/j.apmr.2017.01.016. Epub 2017 Feb 14. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	pain severity	pain severity change by using Numeric Rating Scala will be observed before and at 1, 3 months after the procedure.; pain severity change by using Numeric Ratin Scala was observed 3 months after the procedure.The 11-point numerical scale ranges from '0', representing "no pain", to '10', representing extreme pain (e.g., "pain as bad as you can imagine" or "worst pain imaginable").	1 and 3 months
Primary	Patient satisfaction after the procedure	Patients will evaluate their satisfaction after the procedure as "satisfied", "uncertain" or "not satisfied".	1 and 3 months
Primary	functionallity	Functionality of foot will be observed at before the procedure and 1, 3 months after the procedure. Foot functionalliy index will be used. Foot function index consists of 23 items with 3 subgroups: pain, disability and activity limitation. To calculate the subscales and total score, the scores of each item are summed, divided by the sum of the maximum scores of the items and multiplied by 100. Higher scores indicate more pain, disability, and activity limitation. The survey score varies between 0-100, and as the score increases, the disability increases.	1 and 3 months
Primary	medication use	number of medication use (nonsteroidal anttinflamatort drugs, opioids, muscle relaxants) wiil be evaluated	1 and 3 months