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Radiofrequency Ablation
A New Tool in Our Practice for Heel Pain and Neuromas
Michael Zapf, DPM, MPH, FACFAS
Darren Payne, DPM, AACFAS
Great news for people with HEEL PAIN and
NEUROMAS - May 1, 2007
Radiofrequency ablation (RFA) is a non-surgical
procedure used to treat neuroma and heel pain. After local anesthesia, a
physician guides a catheter with an electrode at its tip to the area of a nerve
lesion like a neuroma or to a painful tissue like the plantar fascial where it
inserts on the heel bone. Then a mild, painless radiofrequency energy (similar
to microwave heat) is transmitted to the tissues causing an injury to the nerves
in the area that will result in less or no pain from the neuroma or plantar
fasciitis. RFA is used by cardiologists for correcting heart beat irregularities
and oncologists for treating some tumors. We are the first doctors in the
northern Los Angeles—Ventura area to use RFA in the foot.
RFA
is done either in the office with local anesthesia or at the surgery center o r
surgery hospital with sedation. For the neuroma three or four areas of the nerve
are treated and for heel pain treatment involves three to six areas of the
nerves. Post-operative care involves a strapping of the foot and tennis shoes
for a few days.
Here is where RFA is
used in the foot
(fOR hEEL pAIN
sEE bELOW)
1. NEUROMAS
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A swollen and painful trapped nerve usually located
between the 3rd and 4th toes but could also be between the 2nd and 3rd toes.
Neuromas and trapped nerves can occur elsewhere in the foot and in areas of a
scar.
Self—home treatment
ê
 | Wider, softer and more
cushioned shoes |
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Over-the-counter insoles
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Ice therapy
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ê
Diagnostic work-up in the office
ê
| Physical examination
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X-rays to rule out boney causes
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Ultrasound to measure the size (more than 5mm is
significant) |
ê
Office treatment
ê
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Up to three cortisone injections |
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Custom
orthotics with neuroma pads |
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Series
of 4% alcohol injections (mild “mini” neuroablation) one week apart for 8
weeks. For more into ->
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ê
RFA IS DONE HERE "BEFORE SURGERY"
IN THE TREATMENT PATHWAY
ê
Theory of RFA
for NEUROMAS: The RFA will “kill” enough
of the nerve that pain relief will be great enough that surgery can be
eliminated or postponed. The regenerated nerve is not as painful as it was
before the RFA.
ê
Surgery
RFA should be tried before surgery in
which the neuroma is removed under local anesthesia with sedation at any
of our local surgery locations. Rarely is this done in the office.
2. HEEL
PAIN - PLANTAR FASCIITIS Inflammation of the plantar fascia where
it attaches at the heel bone often accompanied with bursitis and first-step
pain.
Self- home treatment:
ê
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Heel lifts |
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Over-the-counter insoles |
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Stretching exercises |
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Ice
therapy |
ê
Diagnostic work-up in the
office
ê
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Physical examination |
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X-rays
to look for spurs or stress fractures |
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Ultrasound to measure the thickness of the plantar fascia (More than 5mm thick
is significant) |
ê
Office treatment
ê
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Up to
three cortisone injections |
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Anti-inflammatory pills |
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Custom
orthotics |
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Night
splint |
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Physical therapy |
ê
RFA IS DONE HERE "BEFORE SURGERY" IN
THE PATHWAY OF HEEL PAIN TREATMENT
Theory of RFA
FOR PLANTAR FASCIITIS: The pain of plantar fasciitis is
transmitted by several nerves that can be inactivated by RFA to give time for
the body to “heal” the area. The tissue is injured and healing ends the pain,
ê
Surgery
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Shockwave treatment—ESWT—done usually in the office
under local anesthesia For more info --> |
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Plantar fasciotomy done in the office or at the surgery
facility under local anesthesia -->
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