Do you get permanent foot pain relief after radiofrequency? How soon can the nerve pain come back?

Can Radiofrequency Ablation Have An Impact With Amputation Neuromas?

Recently, we have also approached the treatment of amputation neuromas with radiofrequency ablation. We have had an incredible amount of success with virtually no post-treatment pain and immediate full activity for the patient. The complications from this type of procedure are minimal, including either failure to respond or a slight skin burn. If you think about it, this is an excellent modality as an intermediary step prior to a denervation procedure.

What is a Morton's Neuroma?

A “Morton’s neuroma” is nothing more than a peripheral nerve entrapment.  Removing the nerve, should be a last resort.

Are there any scientific papers regarding the treatment of Neuromas?

References: Morton's neuroma

1. Dellon AL. Treatment of recurrent metatarsalgia by neuroma resection and muscle implantation: case report and proposed algorithm of management for Morton's "neuroma." Microsurgery1989;10(3):256-9.

2. Gauthier G. Thomas Morton's disease: a nerve entrapment syndrome. A new surgical technique.Clin Orthop. 1979 Jul-Aug(142):90-2.

3. Okafor B, Shergill G, Angel J. Treatment of Morton’s neuroma by neurolysis. Foot Ankle Int. 1997 May;18(5):284-7.

4. Vito GR, Talarico LM. A modified technique for Morton’s neuroma. Decompression with relocation. J Am Podiatr Med Assoc. 2003 May-Jun;93(3):190-4.

5. Womack JW, Richardson DR, Murphy GA, Richardson EG, Ishikawa SN. Long-term evaluation of interdigital neuroma treated by surgical excision. Foot Ankle Int. 2008 Jun;29(6):574-7.

6. Schneider RK, Mayhew IG, Clark GL. Effects of cryotherapy on the palmer and plantar digital nerves in the horse. Am J Vet Research 1985; 46:7-12.

7. Dellon AL, Mackinnon SE, Pestronk A. Implantation of sensory nerve into muscle: preliminary clinical and experimental observations on neuroma formation. Ann Plast Surg. 1984 Jan;12(1):30-40.

8. Mackinnon SE, Dellon AL, Hudson AR, Hunter DA. Alteration of neuroma formation by manipulation of its microenvironment. Plast Reconstr Surg. 1985 Sep;76(3):345-53.

9. Meyer RA, Raja SN, Campbell JN, Mackinnon SE, Dellon AL. Neural activity originating from a neuroma in the baboon. Brain Res. 1985 Jan 28;325(1-2):255-60.

10. Nath RK, Mackinnon SE. Management of neuromas in the hand. Hand Clin. 1996 Nov;12(4):745-56.

11. Huibin Q, Jianxing L, Guangyu H, Dianen F. The treatment of first division idiopathic trigeminal neuralgia with radiofrequency thermocoagulation of the peripheral branches compared to conventional radiofrequency. J Clin Neurosci. 2009 Nov;16(11):1425-9.

Is there any research available in the treatment of Heel Pain?

Research:

1. Letcher FS, Goldring S. The effect of radiofrequency current and heat on peripheral nerve action potential in the cat. J Neurosurg. 1968; 29(1):42-47.
2. Smith HP, McWhorter JM, Challa VR. Radiofrequency neurolysis in a clinical model, neuropathological correlation. J Neurosurg. 1981; 55(2):246-253.
3. Leather RA, Leitch JW, Klein GJ, Guiraudon GM, Yee R, Kim YH. Radiofrequency catheter ablation of accessory pathways: a learning experience. Am J Cardiol. 1991; 68(17):1651-5.
4. Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003; 93(3):234-7.
5. Landsman A. Radiofrequency nerve ablation for the treatment of heel pain. Tech Foot Ankle Surg. 2011; 10(2):76-81.
6. Liden B, Simmons M, Landsman A. A Retrospective analysis of 22 patients treated with percutaneous radiofrequency nerve ablation for prolonged moderate to severe heel pain associated with plantar fasciitis. J Foot Ankle Surg. 2009; 48(6):642–647.
7. Sollitto RJ, Plotkin EL, Klein PG, Mullin P. Early clinical results of the use of radiofrequency lesioning in the treatment of plantar fasciitis. J Foot Ankle Surg. 1997; 36(3):215-9.
8. Cozzarelli J, Sollitto RJ, Thapar J, Caponigro J. A 12-year long-term retrospective analysis of the use of radiofrequency nerve ablation for the treatment of neurogenic heel pain. Foot Ankle Spec. 2010; 3(6):338-46.
9. Brinks A, Koes BW, Volkers AC, Verhaar JA, Bierma-Zeinstra SM. Adverse effects of extra-articular corticosteroid injections: a systematic review. BMC Musculoskelet Disord. 2010; 11:206.
10. Tweed JL, Barnes MR, Allen MJ, Campbell JA. Biomechanical consequences of total plantar fasciotomy: a review of the literature. J Am Podiatr Med Assoc. 2009; 99(5):422-30.
11. Rompe JD, Furia J, Weil L, Maffulli N. Shock wave therapy for chronic plantar fasciopathy. Br Med Bull. 2007; 81- 82:183–208.

What other applications does RNFA have in treating Foot Pain?

Does it have other applications?


Answer:

Another application for radiofrequency nerve ablation is with Morton’s neuroma. My success rate with this condition has been good but this frequently requires more than one treatment. I have attributed this to the fact that the nerves are more difficult to localize due to their variable position within the interspace and the need to ablate both intermetatarsal nerves sufficiently to stop the pain.

   In many cases, I am able to partially ablate the nerves on the first treatment. Although this may reduce the pain, it may not eliminate it. However, subsequent ablation becomes easier as the area of pain is smaller. Since the area is smaller, localization of the nerve becomes easier.

(Physician FAQ) At what point in the treatment regiment is it appropriate to refer?

When do I refer?

Answer:
       I now consider radiofrequency nerve ablation in the earliest phases of treatment, even before steroid injections, in order to avoid fat pad atrophy, spikes in blood glucose and other steroid-related complications. Typically, one can perform the procedure in 10 minutes or less.

       Due to the safety profile, proven efficacy and the ease of the procedure, radiofrequency nerve ablation is becoming my treatment of choice rather than a go-to treatment when all else has failed. In over 80 percent of cases, I have found that patients get almost complete relief within one month following a single treatment.

        I have found that the safety profile is outstanding with no worsening of the condition and no significant adverse events. The most common complication was bruising at the injection site.

What are the risks?

^{What are the risks?}

^Answer:

The risks associated with radiofrequency nerve ablation are comparatively low and the clinical outcomes are generally much higher. Although radiofrequency nerve ablation does give relief to those afflicted with inflammation at the origin of the plantar fascia, it is also beneficial for those with scar related heel pain, calcaneal bursitis, nerve entrapments and even fat pad atrophy. Furthermore, radiofrequency nerve ablation does not diminish the strength of the plantar fascia in any way and therefore will not result in medial arch collapse or cuboid crush conditions.

   The types of complications associated with radiofrequency nerve ablation center around the types of problems normally associated with a standard injection. These problems may include a hematoma at the injection site. Also in some cases, one may have to repeat the procedure if the probe was not close enough to the affected nerve at the time of ablation.

How does Radiofrequency Nerve Ablation compare to other treatments?

How does Radiofrequency Nerve Ablation compare to other treatments?

Answer:

However, there are associated risks with many of these treatments. Corticosteroid injections may lead to irreversible soft tissue atrophy and potential rupture. Partial release of the plantar fascia can cause collapse of the arch, cuboid crush symptoms and painful scar formation. Shockwave may not be covered by insurance and research has shown ESWT to produce a significant reduction of symptoms in approximately 50 percent of the cases following a single treatment.

What alternative therapies exist to treat Heel Pain?

What alternative therapies exist to treat Heel Pain?

Answer:
There are two categories, conservative and surgical.
On the conservative front, there are multiple options.  These may include orthotics, injections, oral medications, physical therapy and strappings.  Some consider Extra Corporeal Pulse Activation therapy among these. Provider of this therapy.
On the surgical spectrum, there are varying degrees of intervention.  Radiofrequency Nerve Ablation only requires the insertion of a needle.  It is linked in this category because of the need of anesthesia.  Further on this spectrum, is an endoscopic plantar fasciotomy or open procedure. Videos of these procedures.

How effective is Radiofrequency Nerve Ablation?

^{What is the efficacy of RFNA?}

^Answer:

Multiple studies suggest approximately 90% success rate.

[list studies]

What should a patient experience?

^{What should a patient experience?}

^Answer:

Typically, the patient will report at least 50 percent improvement in the first two weeks and will reach maximum improvement between four and six weeks after treatment. Patients who do not fully respond to treatment during the first four to six weeks should consider a second treatment in order to get maximum relief.

Why does this effectively treat heel pain?

Why does this effectively treat heel pain?

Answer:

Although the etiology is potentially multifactorial, the nerve that transmits the pain remains consistent for most types of heel pain. The posterior and anterior branches of the inferior calcaneal nerve provide sensory innervation to the area where the plantar fascia originates from the calcaneus. The medial calcaneal nerve provides sensory innervation to the more medial aspects of the heel as well as the calcaneal bursa regions. Ablation of these nerves can reduce the deep heel pain associated with each of these areas.

How do we target specific nerves?

How do we target specific nerves?

Answer:

When managing chronic pain, the clinician must identify the associated sensory nerve. Then the clinician must place the radiofrequency nerve ablation probe close enough to the nerve to create sufficient thermal damage to stop conduction. Current devices provide the clinician with a mechanism to assess the position of the probe relative to the nerve by measuring impedance. Impedance is the resistance of the tissues between the tip of the probe and the target nerve. The greater the distance between the nerve and the probe, the greater the impedance will be. The ability to measure impedance between the probe and the nerve represents a significant advance in the treatment of plantar fasciitis with radiofrequency nerve ablation and allows the clinician to move the procedure from the operating room to the pain clinic.

How is it used to treat heel pain?

<sup>How is it used to treat heel pain?


Answer:</sup>

One can easily control pain associated with plantar fasciitis by eliminating the sensory perception of inflammation in the heel. In fact, this technology is effective at reducing or eliminating pain from a variety of etiologies associated with heel pain, including nerve entrapments, scars from open plantar fascial releases, calcaneal bursitis and, of course, plantar fasciitis.

What is radiofrequency ablation?

What is radiofrequency ablation?

Answer:

Radiofrequency nerve ablation uses radiofrequency energy to create heat in a very small area in order to disrupt the myelin sheath on the surface of sensory nerves. The application of heat at 80º to 90ºC for 90 seconds results in gaps in the sheath, thereby stopping conduction of the nerve.