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Ultraschall Med 2016; 37(01): 56-62
DOI: 10.1055/s-0034-1385466
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Ultrasound-Guided Percutaneous Radiofrequency Lesioning When Treating Recalcitrant Plantar Fasciitis: Clinical Results

Ultraschallgestützte perkutane Radiofrequenz-Läsionierung bei der Behandlung der hartnäckigen Plantarfasziitis: Klinische Ergebnisse
P. T. Wu   *
1   Department of Orthopaedics, National Cheng Kung University Hopistal, Tainan, Taiwan
2   Institute of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
,
J. S. Lee   *
3   Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hopistal, Tainan, Taiwan
,
K. C. Wu
2   Institute of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
4   Department of Orthopedics, Kuo’s General Hospital, Tainan, Taiwan
,
T. T. Wu
2   Institute of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
5   Department of Orthopedics, Jen-Chun Hospital, Tainan, Taiwan
,
C. J. Shao
6   Department of Orthopaedics, Tainan Municipal Hospital, Tainan, Taiwan
,
F. W. Liang
7   Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
,
T. C. Chern
8   Chern Tai-Chung’s Orthopedics Clinic, Tainan, Taiwan
,
F. C. Su
2   Institute of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
,
I. M. Jou
1   Department of Orthopaedics, National Cheng Kung University Hopistal, Tainan, Taiwan
› Author Affiliations
Further Information

Publication History

03 March 2014

22 September 2014

Publication Date:
12 November 2014 (online)

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Abstract

Purpose: We evaluated the effects of ultrasound (US)-guided percutaneous radiofrequency thermal lesioning (RTL) and the impact of obesity when treating patients with recalcitrant plantar fasciitis.

Materials and Methods: 30 consecutive patients were enrolled. The visual analog scale (VAS), American Orthopedic Foot-Ankle Society (AOFAS) Ankle-Hindfoot Score, and plantar fascia thickness measured using US were recorded at baseline and at follow-up 1, 3, 6, and 12 months after surgery under local anesthesia.

Results: 12 patients in the obese (BMI ≥ 30 kg/m2) group and 18 patients in the non-obese group. There were significant postoperative decreases in VAS scores and in fascial thickness, and an increase in the AOFAS scores (all p < 0.001). The obese group showed delayed pain and functional improvement within the first 3 months after the index procedure (p < 0.01). Significant pain reduction and functional improvement were apparent earlier (after 1 month, p < 0.001) in the non-obese group than in the obese group (after 3 months, p < 0.05). Fascia thickness was positively correlated with the VAS score and negatively correlated with the AOFAS score (both p < 0.001).

Conclusion: US should be regarded as a useful objective tool to guide RTL and to monitor the effectiveness of treatment. US-guided percutaneous RTL for recalcitrant PF is a minimally invasive treatment option that yields satisfactory results. Therefore, it should at least be considered before using more invasive procedures. Moreover, obesity leads to delayed improvement but does not affect overall outcome after 12 months. Plantar fascial thickness was correlated with VAS and AOFAS scores.

Zusammenfassung

Ziel: Ergebnisbewertung der Ultraschall-gestützten perkutanen Radiofrequenz-Thermal-Läsionierung (RTL) und den Einfluss von Adipositas bei der Behandlung von Patienten mit hartnäckiger Plantarfasziitis.

Material und Methoden: Insgesamt 30 aufeinander folgende Patienten. Die visuelle Analogskala (VAS), der Ankle-Hindfoot-Score der „American Orthopaedic Foot-Ankle Society“ (AOFAS) und die sonografisch bestimmte Dicke der Plantarfaszie wurden zu Beginn und bei den Folgeuntersuchungen 1, 3, 6 und 12 Monaten nach der Operation unter Lokalanästhesie protokolliert.

Ergebnisse: 12 Patienten der Gruppe mit Adipositas (BMI ≥ 30 kg/m2) und 18 Patienten der nicht-adipösen Gruppe. Postoperativ kam es zu einer signifikanten Abnahme der VAS-Scores und der Dicke der Plantarfaszie, sowie zu einem Anstieg der AOFAS-Scores (für alle p < 0,001). Adipositas-Gruppe: Schmerzen zogen sich länger hin und eine verlangsamte funktionelle Verbesserung in den ersten 3 Monaten nach der Index-Prozedur (p < 0,01). Signifikante Schmerzreduktion und funktionelle Verbesserung waren in der nicht-adipösen Gruppe früher (nach 1 Monat, p < 0,001) als in der Adipositas-Gruppe (nach 3 Monaten), p < 0,05) zu verzeichnen. Die Dicke der Faszie korrelierte positiv mit dem VAS-Score und negativ mit dem AOFAS-Score (jeweils p < 0,001).

Schlussfolgerung: Der US sollte als nützliche objektive Methode betrachtet werden, um eine RTL zu unterstützen. Die US-gestützte perkutane RTL bei hartnäckiger Plantarfasziitis ist eine minimal-invasive Behandlungsoption mit zufriedenstellenden Ergebnissen. Deshalb sollte diese vor dem Einsatz von noch invasiveren Methoden auf jeden Fall in Erwägung gezogen werden. Adipositas führt zwar zu einer verzögerten Verbesserung, beeinflusst aber nicht den Gesamterfolg nach 12 Monaten. Die Plantarfaszien-Dicke korreliert mit den VAS- und AOFAS-Scores.

Key words

ultrasound - radiofrequency (RF) ablation - percutaneous - plantar fasciitis - obesity

* P. T. Wu and J. S. Lee contributed equally to this research, and both are first coauthors.


 

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