Posterior Tibial Nerve PRF vs Intralesional RFT for Painful Calcaneal Spur and Plantar Fasciitis
Condition: Heel Spur; Plantar Fascitis
MeSH terms: Fasciitis; Fasciitis, Plantar; Heel Spur
Study type: Interventional

Summary: 
      This study aims to compare the efficacy of ultrasound (US)-guided posterior tibial nerve
      pulsed radiofrequency (PTN PRF) and fluoroscopy (FL)-guided intralesional radiofrequency
      thermocoagulation (RFT) for the treatment of painful calcaneal spur and plantar fasciitis
      refractory to conservative treatments. For this evaluation, a numerical rating (NRS) and the
      American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot scores will be used before
      and after both interventions.
    

Detailed description: 
      Painful calcaneal spurs (PCS) and plantar fasciitis (PF) are common foot conditions affecting
      approximately 10-15% of the population. These conditions can cause severe heel pain and
      disability, affecting the patients' quality of life and productivity.

      Treatment of these conditions is complex and sometimes resistant to conventional therapies,
      such as rest, ice, stretching, orthotics, and anti-inflammatory drugs. Some studies have
      shown that conservative treatments can improve PCS and PF symptoms within 12 months. However,
      if conservative treatments fail, interventional procedures such as corticosteroid injections,
      radiofrequency ablation, or surgery may be used on the PCS and surrounding nerves.

      PRF and RFT are two modalities of thermal ablation that can be used to treat chronic pain
      conditions. PRF delivers short bursts of high-voltage electrical current to the target nerve,
      creating a non-thermal effect that modulates the transmission of pain signals. RFT delivers a
      continuous current that heats the target tissue, causing coagulation, and can promote
      thinning of hard tissues, such as calcaneal spurs and plantar fascia. The PTN is a branch of
      the sciatic nerve that provides sensory and motor innervation to the heel and sole of the
      foot, where calcaneal spurs and PF occur. The advantage of the PTN over its smaller branches
      is that it can be visualized and targeted using US. FL can visualize PCS.

      US-guided PTN PRF and FL-guided intralesional RFT for pain management in PCS and PF have been
      used in a limited number of studies; however, no studies have compared their efficacy and
      adverse event rates.

      The primary aim of this study was to compare the efficacy of these two treatment modalities.
      The secondary aim was to determine the incidence of adverse events associated with US-guided
      PTN PRF and FL-guided intralesional TRF treatment. A total of at least 46 patients, 23
      patients in each group, will be enrolled for comparison. NRS, and AOFAS scores before, 1
      month, and 3 months after treatment will be compared both within and between groups.
    

Intervention name(s): ultrasound-guided posterior tibial nerve pulsed radiofrequency; fluoroscopy-guided intralesional radiofrequency thermocoagulation
Intervention type(s): Procedure; Procedure
Intervention description(s): The posterior tibial nerve (PTN) was identified with a 5-12 MHz linear ultrasonography (US) probe at the level of the medial malleolus, where it runs posterior to the posterior tibial artery. Using the in-plane technique, a 22-gauge, 10-cm radiofrequency cannula was inserted under US guidance and advanced until the tip was adjacent to the nerve. Pulse radiofrequency was applied at 42°C for 240 s with a pulse width of 20 ms; The painful heel and calcaneal spur were visualized under lateral fluoroscopy. A 22-gauge, 10-cm radiofrequency cannula was inserted and advanced until the needle tip reached the calcaneal spur tip. When the needle tip contacted the spur, local anesthetic was administered through the cannula and radiofrequency ablation was performed at 80°C for 90 s.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Pulsed Radiofrequency Treatment; Ultrasonography; Fluoroscopy; Tibial Nerve