Results of the use of modified bipolar radiofrequency ablation in patients with proximal plantar fasciopathy

Background. Among the many causes of plantar heel pain, the most common is proximal plantar fasciopathy (PF), second only to ligamentous injuries of the foot. The disease reduces the quality of life and is difficult to treat, as its pathogenesis remains unexplored. The aim of the study — to conduct a comparative evaluation of treatment outcomes in patients with proximal plantar fasciopathy using extracorporeal shock wave therapy, as well as minimally invasive bipolar radiofrequency ablation, both with and without the described modification. Methods. We analyzed the treatment outcomes of 36 patients who sought medical care for chronic heel pain caused by proximal PF in the period from 2018 to 2023. Among the patients, there were 14 (38.8%) women and 22 (61.2%) men, with a median age of 55.4 [46.7; 61.7] years. All patients were randomly assigned to three groups of 12 patients each. In Group 1 (control), extracorporeal shock wave therapy (ESWT), which had not been used at previous stages, was used for treatment; in Group 2 (comparison) — minimally invasive bipolar radiofrequency ablation (BRFA); in Group 3 (main) — minimally invasive BRFA using a method modified by the authors. Comparative evaluation of the results was carried out at 1, 3, 6 and 12 months after surgery in Groups 2 and 3 and after the completion of ESWT course in Group 1. Results. The median plantar fascia thickness of the affected limb did not differ between the groups at 3 months after the completion of treatment. At 6 months, these indicators were significantly different between the control and main groups (p = 0.001). In the intergroup analysis of the dynamics of pain syndrome and foot functionality, the treatment results in the main group showed a statistically significant advantage compared with control and comparison groups after 1, 3 and 6 months of follow-up (p 0.05). Conclusions. The modified minimally invasive radiofrequency ablation method for the treatment of patients with proximal plantar fasciopathy demonstrated superior early clinical outcomes compared to the standard ablation technique and a course of extracorporeal shock wave therapy. The results obtained appear promising and suggest that the modified technique may be considered a preferred treatment option in cases where all types of conservative therapy fail within a six-month period.