Yildiz G, Perdecioglu GRG, Yuruk D, et al. Comparison of tibial nerve pulsed radiofrequency and intralesional radiofrequency thermocoagulation in the treatment of painful calcaneal spur and plantar fasciitis: A randomized clinical trial. Pain Med. 2024 Apr 23:pnae029. doi: 10.1093/pm/pnae029. (Original study)

OBJECTIVE: Ultrasound-guided tibial nerve pulsed radiofrequency (US-TN PRF) and fluoroscopy-guided intralesional radiofrequency thermocoagulation (FL-RFT) adjacent to the painful calcaneal spur are two interventions for pain management in painful calcaneal spur (PCS) and plantar fasciitis (PF). This study aimed to compare the effectiveness of the two procedures.

DESIGN: A prospective, randomized, single-blind study.

SETTING: Single-center pain clinic.

SUBJECTS: Forty-nine patients who met the inclusion criteria were randomized into two groups.

METHODS: 25 patients (group U) received US-TN PRF at 42 °C for 240 s, while 24 patients (group F) received intralesional FL-RFT at 80 °C for 90 s. The most severe Numeric Rating Scale (NRS) score during the first morning steps and the American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot scores were used to evaluate the effectiveness of the procedures. The study's primary outcome assessed treatment effectiveness using the NRS, whereas the secondary outcomes included changes in the AOFAS score and the incidence of procedure-related mild adverse events.

RESULTS: NRS and AOFAS scores significantly improved in groups U and F at 1 and 3 months compared to baseline (p < 0.05), and there was no significant difference between the groups. At month 1, 50% or greater pain relief was achieved in 72% of patients in group U and 75% in group F. No significant difference was observed in the incidence of mild adverse events between the groups.

CONCLUSIONS: US-TN PRF and intralesional FL-RFT have shown significant effectiveness in the treatment of PCS and PF. Larger randomized controlled trials are needed.

Discipline Area Score
Physician 6 / 7
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Comments from MORE raters

Physician rater

In this single-center pain clinic, both ultrasound-guided tibial nerve pulsed radiofrequency and intralesional radiofrequency thermocoagulation demonstrated comparable efficacy in providing short-term (3 months) pain relief for refractory painful calcaneal spur and plantar fasciitis, with no discernible differences in the incidence of mild adverse events. However, the authors did not assess the impact of these interventions on drug consumption. Consequently, the clinical utility of the conclusions is limited. Large well-planned trials are necessary to ascertain the real efficacy of these techniques.
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