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A New Minimally Invasive Technique for Treating Plantar Fasciosis Using Bipolar Radiofrequency: A Prospective Analysis
Lowell Weil, JR, Jason P. Glover, Lowell Scott Weil, SR, Foot & Ankle Specialist, Vol. 1, No. 1, 13-18 (2008)
Quote:
The purpose of this study was to evaluate the effectiveness of a new minimally invasive technique using bipolar radiofrequency in the treatment of plantar fasciosis. A prospective study was performed on 10 patients with recalcitrant plantar fasciosis that failed conservative care. A percutaneous microtenotomy was performed unilaterally with a Topaz microdebrider. Outcome measures included visual analog scale, American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot and Midfoot Scale, and patient satisfaction assessment. All patients had statistical improvement in outcome measures at 6 months and 1 year. One patient developed recurrent heel pain at the 1-year mark. There were no postoperative complications. This minimally invasive technique is a viable surgical treatment option in patients with plantar fasciosis that failed conservative care.
Here is a news story from 4 weeks ago on this method: New treatment could cure chronic heel pain
1/14/2008 12:05 PM
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Some people will not achieve the pain relief they need with non-surgical treatments and may need to resort to surgery to relieve the pain.
Millions of Americans suffer from heel pain, which is most often caused by plantar fasciitis.
According to the American College of Foot and Ankle Surgeons, stress fractures, tendonitis, arthritis and nerve irritation can also cause heel pain.
Doctors with the American College of Foot and Ankle Surgeons recommend first trying non-invasive treatments to relieve heel pain. These include stretching, avoiding bare feet, ice, shoe modifications, over-the-counter medications such as ibuprofen and/or maintaining a healthy weight (extra weight means extra stress on your feet).
If the pain lasts for several weeks or longer, experts say patients may want to try more involved treatments such as custom orthotic shoe devices, corticosteroid injections, removable walking casts or wearing night splints. Some people will not achieve the pain relief they need with non-surgical treatments and may need to resort to surgery to relieve the pain. But a new, non-invasive treatment could be much easier than surgery and more desirable for patients.
The new procedure -- called TOPAZ -- can treat chronic heel pain in about 20 minutes. It's used to debride the soft tissue in the heel and stimulates healing. Doctors use a series of small punctures at specific target spots in the heel. A wand is then slipped through the skin at those points to deliver radiofrequency energy for one-half second treatments. The energy is delivered at points that are about one quarter inch apart. Light anesthesia is used for the procedure.
Marlene Reid, DPM, from the Family Podiatry Center in Westmont, IL, says, "It's radio frequency that is delivered to the tissue. That increases oxygen, it increases vascular supply and allows healing to begin. It delivers energy that sort of kick starts the healing process."
Dr. Reid says TOPAZ has changed patients' lives in her practice. She says, "The success rate so far is much greater than open heel surgery. It is a minimally invasive procedure. Patients are back on their feet much sooner than if they had to have an open incision. They are back to their activities much sooner ... and the healing time is much quicker."
An open procedure using TOPAZ that requires a one inch incision is currently FDA-approved and is covered by most insurance companies. The newer TOPAZ procedure in which the wand is inserted through the skin with no open incision is not yet FDA approved and is currently under study. However, some doctors are doing the procedure through the skin as an "off label" treatment
Re: Bipolar radiofrequency for plantar fasciitis (TOPAZ)
I have been using TOPAZ for about a year now for fascitis using both the open and percutaneus methods. I feel the open method is more predictable since you can see what the device is doing. The percutaneus method does work, but you need a bit more "feel" to be able to make it sucessful.
The beauty though, of the percutaneus method is that it can be performed in an office based setting wheras the open procedure should be performed in the O.R setting.
Dr. Eickmeier: Can you discuss how you perform Coblation therapy, or the Topaz procedure, for plantar fasciosis and any pearls that you may have?
Dr. Werber: I use a very traditional endoscopic approach. I would have localized the pain prior to
anesthetizing the patient. I would look and feel for the medial band of the plantar fascia as it is approaching the medial tubercle of the calcaneus,and make a medial incision. I then take a Kelly hemostat or a Freer elevator and I would feel for the inferior surface of the plantar fascia. I migrate my way across with the Kelly to create the tunnel.
Then I take my trocar and cannula and go through the initial tunnel I have created. Keeping the foot maximally dorsiflexed so the plantar fascia is extremely tight, I will then gradually, using a windshield wiper motion, move along the inferior surface of the plantar fascia until I reach the lateral margin of the heel. At this point, I will make a secondary incision that is curved with the skin lines.
I know this seems very minimal but going along with the skin lines on that lateral incision seems to decrease the postoperative pain in this area. As I bring the cannula and trocar across, I remove the trocar and take some cotton swabs to clean the cannula. Then I visualize the plantar fascia and make sure that I am well localized.
At this point, I introduce the Topaz wand and it certainly cannot be a dry field.We will flood the cannula with saline and then I create my matrix of insertions into the plantar fascia.I roll the cannula to the posterior, repeat the procedure, and roll it anteriorly. Sometimes I will lengthen my medial incision to angle and swing the cannula distally or proximally if I feel that I need to get more of the fascia. Remember that you have a thickened plantar fascia. Accordingly, when you are bringing the Topaz wand into the fascia, you do not want to just get the surface of the fascia. You need to get into the substance of the fascia and try to get to the superior surface with the wand. You need to make sure the insertions of the wand do penetrate the plantar fascia as opposed to just treating it superficially. Then I obviously flush the area, remove my instrumentation and do a closure.
Dr. McGlamry: Are you introducing the wand from medial with the cannula position lateral?
Dr. Werber: Yes.
Dr. Eickmeier: Dr. McGlamry, can you discuss any pearls that you may have for us?
Dr. McGlamry: My approach has really been more of the open approach through a traditional in-step fasciotomy-type incision. As Dr.Werber mentioned, pre-operatively, I try to isolate the patient’s point of maximal tenderness and put a bull’s eye right on it. We then create about a 2- to 2.5-cm incision, typically sweeping from the medial aspect of the heel just anterior to the tubercle area and then sweeping about halfway across the heel. We sharply dissect directly through the fat. One of the advantages with this is that it is typically directly in line with the medial calcaneal nerve branches. With a little bit of care, you can pretty much avoid this and if you do see calcaneal nerve branches, you can safely retract them
within the fatty layer.
Carry dissection directly down to the plantar fascia and insert a self-retaining retractor. This will give you a clear exposure of about 1 to 2 cm of the fascia. With that exposure, I am able to produce a treatment grid, typically with 12 to 16 penetrations of the fascia directly over the point of maximal tenderness. After a quick irrigation, we close it with some interrupted mattress stitches. We utilize a dry sterile dressing, typically with an Ace bandage around the top, and walk patients right out of the surgery center that day. They are fully weightbearing from day one.
My colleagues and I have done a lot with plantar incisions in the last few years. The old rhetoric about it being taboo to make incisions on the bottom of the foot and allowing immediate weightbearing has not held water. We have had beautiful incisions and beautiful results. Of course, sometimes you may get some little keratoma areas if you are using some wired stitches. However, we have not had any significant problems with these incisions to date. The plantar incisions have healed well with immediate weightbearing.
Perhaps the biggest pearl I can offer is making the incision directly over the point of maximal tenderness. I would imagine that my surgical time, which is not the measure of success, is typically under 20 minutes for these plantar fascial procedures. I do them under tourniquet. It gives us a nice dry field with clear visualization of the fascia. The patient is out of the surgery center or the hospital recovery room typically within 30 minutes or so afterward.
Reviewing Anectodal Results And Identifying Non-Responder Patients
Dr. Eickmeier:What has your success rate been with using the Topaz?
Dr. McGlamry: In my experience,Topaz has in excess of a 90 percent success rate. The failures that I have are on the non-traditional plantar fasciosis patients.
Dr. Eickmeier: When you refer to the non-traditional plantar fasciosis patient, what type of patient are you referring to?
Dr. McGlamry: The stereotypical heel pain patients most of us see in our offices are patients with increased body mass index (BMI), certainly higher weight and who are relatively sedentary. Virtually all of my failures with Topaz have been with people who probably fall in a near normal BMI category. I think I have had three actual failures and two of the three had an underlying cavus foot structure as well.
Dr. Eickmeier: Can you allude as to why some patients have failed to respond to the Topaz procedure?
Dr. McGlamry: I cannot give you a good explanation as to why I think they have failed. The only thing I can say is the observation that they are definitely in a different group. They are slender and generally have had a much longer history of heel pain. One of them is a runner with an eight-year history of heel pain who has previously failed every treatment from a conservative standpoint. She has had physical therapy, multiple pairs of orthotics, injections, antiinflammatories and oral steroids, all to no avail.
Another more recent failure is a male in manual labor and he falls into what you would typically see in a failure group with the EPF. He goes back to standing and walking on concrete even though I kept him out of work for a full month with limited activities in his orthotics. He is a big guy but certainly not obese. He does not have a weight that is out of proportion to his structural frame. Is he better than he was? He is not a failure but certainly not one of the glowing successes that I have.
It certainly has not been a frequent thing. I still reserve any kind of surgical treatment for non-responders who have effectively failed significant attempts at conservative care. I do not want to give the impression that I am doing Topaz procedures three times a week on heel pain patients. I am still probably only doing eight to 10 a year for my non-responders, the group that has shown no significant improvement with conservative care before I have proceeded to the Topaz procedure.
However, Topaz has changed my treatment protocol in that when I have a patient with plantar fasciosis who is not responding to conservative therapy, I am no longer waiting a full six months. If these patients do not have 60 to 80 percent improvement after two months of conservative care, I start to present Topaz as an alternative option and give them realistic statistics. I send them to the Web site (www.topazinfo.com). I try to give them other sources of information to look at as far as alternatives. I begin to present this as a treatment option in the two- to three-month range now for the patients whom I feel are non-responders,the ones who are more fasciosis patients than fasciitis patients.
Dr. Eickmeier: Dr.Werber,can you discuss your experience with patients who have not responded to the
Topaz procedure and why that may be the case?
Dr. Werber: I feel we need to look at both fasciosis and tendonosis. We have experienced about a 10 to 15 percent overall failure rate despite our very thorough exam and treatment. I look back at some of these failures and some of them may be due to a missed a nerve entrapment syndrome. They may have some lower back issues that may be contributory. I did find a couple that had a common peroneal nerve entrapment. We subsequently performed a common peroneal nerve decompression and it alleviated the symptoms for both patients. I am not saying this would work for everybody. It just happened to be the case with these two patients.
Sometimes I believe the failures are in my inability to fully diagnose and appreciate what is going on with the patient. I do agree with Dr.McGlamry’s categorization of the non-responders as having a classical high arch
cavus foot type, lean body mass and being runners. I have seen these same type of non-responders. You have to be aware that there are patients who will fail. Coblation therapy is not a cure-all. It is just another wonderful tool in our armamentarium to treat patients.
Final Notes
Dr. Eickmeier: Are there any closing remarks you would like to make in regard to this discussion of plantar fasciitis and plantar fasciosis?
Dr. McGlamry: Having the Topaz tool in my belt has affected my treatment of patients with plantar fasciosis. Traditionally, we are always taught somewhere along the line that we do not offer surgical intervention for patients with plantar fascial symptoms under six months to a year, depending on who trained you and different schools of thought. The minimally invasive nature of this procedure and the fact that we are not sacrificing normal anatomy have provided me the comfort level to offer patients an option when they are not responding to conservative care whereas before, I felt like I needed to satisfy an arbitrary time period with conservative therapy.
I certainly do discuss this with the patient. However, I am happy that I have yet another mechanism to treat and take care of patients instead of having them come in every three to four weeks for a refill of antiinflammatories and seeing their discouragement when they are not responding to typical conservative care.
I feel the Topaz procedure has advanced my ability to treat patients and give them a potential positive outcome. Certainly,there are no guarantees of success but it does provide us another option and mechanism to treat patients in a minimally invasive nature with a rapid recovery and,in my experience,very few downsides.
Dr. Werber: I have to agree with Dr.McGlamry. Topaz certainly has given us an alternative method of treating heel pain. It has expanded our vision as to why some patients respond very quickly while others have not. This has really advanced our understanding. We still have much to learn and I think the frequency and rapid nature of our expansion of this knowledge on plantar fasciitis and plantar fasciosis will be incredible over the next several years.
Re: Bipolar radiofrequency for plantar fasciitis (TOPAZ)
A big salute. First, congratulate them on the development of the technique TOPAZ, I contact you for information about the protocols used by post after the implementation of the variant of the technique is minimally invasive, ok?.
Regards from Spain of a podiatrist friend.
__________________ D. Pedro J. Pérez Polo, Podólogo.
Clinica del Pie
Avda/ del Perú, 25 LOCAL
Badajoz 06011 pjp_xp@hotmail.com
Re: Bipolar radiofrequency for plantar fasciitis (TOPAZ)
Hello
I have just found this article using google...hope it helps
Im also very interested in this technique if someone has any more information, I would appreciate.
Re: Bipolar radiofrequency for plantar fasciitis (TOPAZ)
A retrospective study of radiofrequency thermal lesioning for the treatment of neuritis of the medial calcaneal nerve and its terminal branches in chronic heel pain.
Cione JA, Cozzarelli J, Mullin CJ. J Foot Ankle Surg. 2009 Mar-Apr;48(2):142-7.
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We undertook a retrospective analysis of 75 consecutive patients with recalcitrant plantar heel pain caused by calcaneal neuritis, all who were treated with radiofrequency thermal lesioning (RTL). The median age of the cohort was 55 (range 24 to 83) years, 25 (33.3%) of the patients were male, 50 (66.7%) of the patients were female, and 15 (20%) of the patients were treated for bilateral heel pain caused by medial calcaneal neuritis. The median preoperative VAS score was 9 (range 2 to 10), whereas the median long-term postoperative VAS score was 1 (range 0 to 8), and this difference was highly statistically significant (P < .0001). Five (6.7%) of the patients experienced recurrent heel pain, over a median follow-up duration of 18 (range 12 to 36) months. Overall, 93.3% of the patients experienced satisfactory pain relief with radiofrequency lesioning for the treatment of recalcitrant plantar heel pain caused by medial calcaneal neuritis
Re: Bipolar radiofrequency for plantar fasciitis (TOPAZ)
Quote:
Originally Posted by NewsBot
A retrospective study of radiofrequency thermal lesioning for the treatment of neuritis of the medial calcaneal nerve and its terminal branches in chronic heel pain.
Cione JA, Cozzarelli J, Mullin CJ. J Foot Ankle Surg. 2009 Mar-Apr;48(2):142-7.
How much of the improvement was due to placebo? I guess we will never know without a control group.
Re: Bipolar radiofrequency for plantar fasciitis (TOPAZ)
hi, I am from india, happy to hear about the topaz treatment . But can some body help in explaning about this,what is bipolar radiofrequency?? how much frequency is used? whether this apparatus expensive and easily available in india:
Re: Bipolar radiofrequency for plantar fasciitis (TOPAZ)
A Retrospective Analysis of 22 Patients Treated with Percutaneous Radiofrequency Nerve Ablation for Prolonged Moderate to Severe Heel Pain Associated with Plantar Fasciitis.
Liden B, Simmons M, Landsman AS. J Foot Ankle Surg. 2009 November - December;48(6):642-647
Quote:
A retrospective study involving 22 patients (31 feet) with a history of prolonged moderate to severe heel pain associated with plantar fasciitis were examined to determine if ablation of the sensory branch of the medial calcaneal nerve would result in symptomatic relief. Participants in this study were given subjective questionnaires and visual analog scales in order to rate their symptoms before and after nerve ablation using radiofrequency energy. The results showed that the mean preintervention visual analog pain score was 8.12 +/- 1.61 (with 10 being the worst pain the patient could imagine), and this dropped to 3.26 +/- 1.97 after 1 week and 1.46 +/- 1.76 after 1 month, 1.96 +/- 1.98 at 3 months, and 2.07 +/- 2.06 at 6 months, and the improvement was statistically significant (P < .001) at each stage of follow-up. Furthermore, patients followed for up to 1 year showed no significant worsening of symptoms. Adverse events were limited to hematoma at the site of entry of the radiofrequency cannula. These findings support the conclusion that radiofrequency nerve ablation be considered an alternative to repetitive corticosteroid injections or open surgical intervention for the treatment of recalcitrant plantar heel pain.
Background
Microtenotomy coblation using a radiofrequency (RF) probe is a minimally invasive procedure for treating chronic tendinopathy. It has been described for conditions including tennis elbow and rotator cuff tendinitis. There have been no studies to show the effectiveness of such a procedure for plantar fasciitis.
Methods
14 Patients with plantar fasciitis with failed conservative treatment underwent TOPAZ RF treatment for their symptoms between 2007 and 2008. The RF-based microdebridement was performed using the TOPAZ Microdebrider device (ArthroCare, Sunnyvale, CA). There were 6 men and 8 women with an average age of 44.0 years (23–57). There were 15 feet, with 6 right and 9 left feet. They were followed up for up to 6 months thereafter. Pre-operative, 3 and 6 months post-operative AOFAS ankle-hindfoot and SF-36 scores were analysed.
Results
There was a significant improvement in mean pre-operative, post-operative 3- and 6-month AOFAS hindfoot scores from 34.47 to 69.27 and 71.33 (p = 0.00) respectively. There was a significant decrease in SF-36 for bodily pain, and significant increases in physical and social function scores. 12 out of 14 (85.7%) patients reported good to excellent satisfaction results at 6 months, and 12 out of 14 (85.7%) patients have had their expectations met from the procedure at 6 months follow up.
Conclusion
TOPAZ RF coblation is a good and effective method for the treatment of recalcitrant plantar fasciitis. Early results are encouraging, and we will continue to assess the patients over a longer follow-up period.
The authors discuss their rationale for the use of radiofrequency nerve ablation (RFNA) in the treatment of chronic neurogenic heel pain. Patients treated for plantar fasciitis who fail to improve after conservative and/ or surgical treatment should be reevaluated for a coexistent nerve entrapment. The results of a retrospective study of 82 patients who have undergone RFNA are presented. The patients were followed at 5, 10, and 12 years after the procedure. An evaluation of medical records was performed as a means of inclusion in this study. A standardized telephone interview was then done, and subjectively scored responses of the patients were recorded and analyzed. Of the patients, 89% reported no recurrence of pain after 5, 10, and 12 years postoperatively. The procedure is relatively easy to perform and involves inserting a 22-gauge cannula with an electrode into the areas of pain. This is done under general anesthesia. It takes approximately 15 to 20 minutes per heel to perform, depending on how many sites of tenderness have been identified. The patient is discharged with a minimal bandage and returns to shoe gear immediately following the procedure. The success rate with RFNA appears to be quite high with fewer associated risks and less post-operative morbidity
Success rates for traditional methods of surgical intervention for chronic plantar fasciosis are low, and associated with high rates of complications and long recovery times. The purpose of this prospective case series was to assess the effectiveness of percutaneous bipolar radiofrequency microfasciotomy for the treatment of recalcitrant proximal plantar fasciosis in 21 patients. The mean preoperative American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score was 22.10 ± 12.96 (out of a possible 68 points) and the mean postoperative AOFAS hindfoot score was 59.57 ± 13.23 points, and this difference was statistically significant (P < .0001). A total of 7 (33.33%) patients experienced satisfactory pain relief within 1 to 4 weeks and 10 (47.62%) did so within 1 to 4 months, whereas 2 (9.52%) patients required longer than 4 months, and 2 (9.52%) others never attained satisfactory relief of symptoms. Fourteen (66.67%) patients subjectively rated their outcome as excellent, 4 (19.05%) as good, 1 (4.76%) as fair, and 2 (9.52%) as poor. One (4.76%) patient experienced iatrogenic flexor hallucis longus tendonitis. The results of this clinical investigation indicate that bipolar radiofrequency microdebridement plantar fasciotomy safely alleviates recalcitrant heel pain. The technique is minimally invasive and simple to perform, and it spares the overall integrity of the plantar fascia without being associated with undue complications.
Re: Bipolar radiofrequency for plantar fasciitis (TOPAZ)
I've had great success with the topaz procedure. I perform them open. I have tried the percutaneous method, but is is difficult to guide the wand where you want it to go. It is best done with a flouro unit.
The purpose of this study was to present the results of a relatively new, minimally invasive surgical technique for the treatment of chronic plantar fasciitis in 14 patients, 2 of whom underwent the treatment bilaterally one foot at time on separate occasions. This was a retrospective, multicenter, nonrandomized study. All of the patients had failed conservative therapy and had symptoms for at least 6 months. The mean follow-up duration was 15.25 months (range, 6-33 months). The postoperative mean American Orthopaedic Foot & Ankle Society hindfoot score was 82.06 (range, 56-100). None of the patients developed complex regional pain syndrome, and all but 2 (14.29% of patients, 12.5% of feet) of the patients were able to return to regular shoe gear by 2-4 weeks postoperative, and only 1 (7.14% of patients, 6.25% of feet) patient was considered a treatment failure. Based on our experience with minimally invasive percutaneous bipolar radiofrequency plantar fasciotomy, we believe the technique to be a relatively easy intervention that is effective and requires less healing time in comparison with traditional open surgical procedures.
Re: Bipolar radiofrequency for plantar fasciitis (TOPAZ)
Use of pulsed radio frequency energy in the effective treatment of recalcitrant plantar fasciitis: Six case histories.
Michel R. Foot (Edinb). 2012 Jan 18.
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Plantar fasciitis (or Heel Pain Syndrome) is a common foot disorder. Whereas most patients with this condition have satisfactory outcomes with conventional treatment, the condition can become recalcitrant. For these patients, the use of Pulsed Radio Frequency Energy (PRFE) appears to be a safe, noninvasive, and effective treatment option. While PRFE has been used to provide pain relief for other clinical conditions, little clinical information is available regarding its effectiveness for the treatment of plantar fasciitis. Reported here are outcomes for six cases of recalcitrant plantar fasciitis (duration 6 months or longer) that were unresponsive to conventional treatment alone, for which complete or near complete pain relief was achieved following adjunctive PRFE therapy.
Background
Microtenotomy coblation using a radiofrequency (RF) probe is a minimally invasive procedure for treating chronic tendinopathy. It has been described for conditions including tennis elbow and rotator cuff tendinitis. There have been no long term studies to show its effectiveness in plantar fasciitis.
Methods
A prospective non-randomised trial was conducted on 48 patients who had failed conservative treatment for plantar fasciitis, between 2007 and 2009. The procedure was performed using the TOPAZ microdebrider device (ArthroCare, Sunnyvale, CA), either via an open or a percutaneous method. Fifty-nine feet were treated and followed up for up to 1 year thereafter. Preoperative, 3, 6 and 12 months post-operative VAS pain, American Orthopaedic Foot-Ankle Society (AOFAS) hindfoot and SF-36 scores, patient expectation and satisfaction scores were analysed.
Results
VAS scores improved significantly in both groups at 1-year follow-up. The open group had a more significant improvement in the VAS score at 1-year follow-up. AOFAS hindfoot scores improve significantly for both groups pre- and post-operatively, but there was no significant difference between both groups at the 1-year mark. SF-36 scores showed equally significant improvement in both groups 1 year post-operatively. Expectation and satisfaction scores were equally high in both arms.
Conclusions
TOPAZ RF coblation is a good and effective method for the treatment of recalcitrant plantar fasciitis. Clinical results improve with time for up to 1-year post-operatively. The open method seems to have a more significant improvement in pain VAS scores at 1-year postoperatively.
Re: Bipolar radiofrequency for plantar fasciitis (TOPAZ)
A Prospective, Randomized, Double-blinded Study with Crossover to Determine the Efficacy of Radio-frequency Nerve Ablation for the Treatment of Heel Pain
Adam S. Landsman, Dominic J. Catanese, Steven N. Wiener, Douglas H. Richie, Jr., Jason R. Hanft
JAPMA January/February 2013 vol. 103 no. 1 8-15
Quote:
Background: Previous studies have demonstrated that radio-frequency nerve ablation (RFNA) can be an effective treatment for plantar fasciosis. This study provides additional evidence in support of this treatment, with statistically significant data that demonstrate the success of this technique.
Methods: In this multicenter, randomized, prospective, double-blinded study with crossover, 17 patients were divided into two groups, with eight initially receiving RFNA treatment and nine initially receiving sham treatment. If no improvement was observed after 4 weeks, a crossover was offered. Results of the treatment were evaluated by the patient and by a blinded physician using a visual analog pain scale to rate first-step pain, average pain, and peak pain in the heel region.
Results: We observed a statistically significant improvement in the symptoms of plantar fasciosis in patients actively treated with RFNA and no significant improvement in the sham-treated group. More important, those treated with sham subsequently demonstrated statistically significant improvement after subsequent RFNA treatment.
Conclusions: Using a prospective, randomized study with sham treatment and crossover, this study demonstrates the efficacy of RFNA for the treatment of plantar fasciosis.
Bipolar radiofrequency for plantar fasciitis (TOPAZ)
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