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Ultrasound-Guided Radiofrequency Denervation of the Medial Calcaneal Nerve
Peter D Counsel1, Marcus Davenport, Angus Brown
1*Imaging at Olympic Park, Melbourne, Australia; †Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; and ‡Department of Diagnostic Radiology, Singapore General Hospital, Singapore.
Objective:
Plantar fasciosis is a common complaint of athletes, particularly for runners. The medial calcaneal nerve (MCN) may play a role in the pain syndrome, and radiofrequency (RF) denervation has been previously reported. The hypothesis is that ultrasound-guided denervation of the MCN results in symptomatic improvement.
Design:
Retrospective cohort.
Setting:
Private practice.
Patients:
Twenty-nine patients previously receiving ultrasound-guided RF denervation of the MCN, having failed conservative therapy, were assessed in 2 groups, those more than (group 1, n = 16) or less than (group 2, n = 13) 6 months since the procedure.
Interventions:
Ultrasound-guided RF denervation of the MCN.
Main Outcome Measures:
Pain scores before denervation, as well as at maximal pain relief and the time of the interview. Levels of satisfaction and attitudes toward surgery were also assessed.
Results:
Pain scores decreased significantly in both groups, for both best and residual pain scores. Group 1 mean pain scores were 8.56 before procedure, 2.81 (P < 0.001 compared to baseline) at best pain score, and 3.75 (P < 0.01) residual pain score. Group 2 mean pain scores were 7.23 before procedure, 3.77 (P < 0.01) at best pain score and 4.92 (P < 0.01) residual pain score. Levels of satisfaction were predominantly positive (69% of group 1% and 54% of group 2 were either somewhat or very satisfied), with attitudes toward surgery unchanged.
Conclusions:
For patients with refractory plantar heel pain, ultrasound-guided denervation of the MCN can potentially improve symptoms, although efficacy needs assessing in comparative studies.
Clinical Relevance:
Ultrasound-guided denervation of the MCN provides a further management option for patients with refractory plantar fasciosis.
