SLR - January 2024 - Bustos
Title: Treatment of Plantar Fasciitis in Patients with Calcaneal Spurs: Radiofrequency Thermal Ablation or Extracorporeal Shock Wave Therapy?Reference: Tas, Nevsun Pihtili, and Oğuz Kaya. “Treatment of Plantar Fasciitis in Patients with Calcaneal Spurs: Radiofrequency Thermal Ablation or Extracorporeal Shock Wave Therapy?.” Journal of clinical medicine vol. 12,20 6503. 13 Oct. 2023, doi:10.3390/jcm12206503
Level of Evidence: Retrospective cohort study = Level III
Scientific Literature Review
Reviewed By: Lindsey Bustos
Residency Program: Scripps Mercy Hospital San Diego, CA
Podiatric Relevance: This article pertains to the treatment of plantar fasciitis which is a common patient diagnosis in podiatric medicine and the most common cause of heel pain. The aim of the study was to compare the effectiveness of extracorporeal shock wave therapy (ESWT) and radiofrequency thermal ablation (RFA) on pain, disability, and activity limitation in the treatment of plantar fasciitis in patients with calcaneal spurs. Both treatment methods have shown good results in plantar fasciitis patients however to the authors knowledge these two methods had not been compared directly.
Methods: This is a retrospective cohort study which included patients whose clinical examination and X-ray films were consistent with plantar fasciitis and calcaneal spur. These patients have failed prior conservative treatments involving oral anti-inflammatory medication, insoles, and corticosteroid injection. Patients were divided into two groups: 1) received ESWT treatment and 2) received RFA treatment for four weeks. The study included 79 patients from the RFA group and 80 patients from the ESWT group. ESWT treatment consists of 3 weekly sessions repeated over 3 weeks. RFA treatment was done under a sterile field and local anesthesia. An evaluation was performed on average 6 months after the treatment. In this study, visual analog scale scores were used to assess pain intensity, and foot function index and roles Maudsley scores were used to assess foot pain, disability, and activity limitation.
Results: This study included 79 RFA patients and 80 ESWT patients. Regarding age and BMI, there were no significant differences between the patient groups. There was a significant decrease in VAS scores after treatment in both the RFA and ESWT groups. The decrease in FFI pain, FFI activity restriction, FFI disability, and RM scores were significant in both groups, but the scores after treatment were lower in the RFA group.
Conclusions: This study adds to the literature investigating the efficacy of ESWT and RFA on plantar fasciitis treatment. It was observed that both treatment methods were effective in reducing pain, and although the FFI disability and activity limitation score of patients in the RFA group were higher, the post-treatment scores were significantly reduced compared to ESWT. Similar improvements in pain scores were observed in both the ESWT and RFA groups. The data supports theses treatment options although I do not think it supports one treatment over the other very strongly. They recommend that patients who suffer from more restraint in their daily activities may prefer RFA over ESWT since ESWT appeared more effective in VAS scores and RFA more effective in function scores. No complications were seen in any of their patients. The follow up is lacking at only 6 months. One would be inclined to incorporate these treatment options into practice in patients with refractory plantar fasciitis, however without drawing a definite conclusion on one being more effective than the other.