Radiofrequency Ablation For Foot Pain

In the past when conservative treatments like cortisone injections, orthotics, physical therapy and padding failed to achieve relief for conditions like heel pain or painful neuromas there were only two options: surgery or live with the pain.

Thankfully now there is another treatment alternative which I have been able to deliver to my patients with great success. That procedure is called Radiofrequency Ablation. 

Radiofrequency Ablation, or RFA, is a procedure that has been used for decades in numerous medical fields such as cardiology, oncology as well as in the back and spine. More recently it has been applied to conditions of the foot.

RFA is a technology that uses electromagnetic energy to essentially generate heat in a very tiny, precise area.  This heat is used to ablate a targeted tissue. In podiatry we typically use this energy to ablate painful nerve signals.

RFA in the podiatry can be used to treat:

• Heel pain
• Plantar Fasciitis
• Baxter’s Neuritis and Medial Calcaneal Neuritis (nerves of the heel)
• Morton’s Neuroma (intermetatarsal neuroma)
• Surgical nerve damage and entrapments

RFA can benefit a patient who has tried or failed other conservative treatments for their condition and is perhaps even considering surgery. RFA is often a great alternative to surgery and has several advantages over surgery:

• The procedure is a same day, in office procedure
• RFA requires no general anesthesia (local anesthesia is all that is needed)
• There is no incision, sutures or wound care
• RFA is often safe enough to be performed on patients who are not otherwise good surgical candidates.
• No post procedure activity or weight bearing restrictions (no crutches or surgical shoe needed)
• Narcotic medication are not typically needed or prescribed
• RFA does not “burn bridges”- You can still have surgery later if needed
• RFA does not cause painful stump neuromas like surgery can

RFA does not typically result in permanent destruction of a targeted nerve. It more or less “resets” the nerve.  Nerves typically regenerate 6months to a year afterwards.  Most of the time the nerves regenerate without a return in pain but sometimes pain does return and another procedure may be performed.

The procedure is performed in an office setting and the procedure itself takes between 30 minutes to an hour depending on the location and the number of nerves targeted. The foot is cleansed in a sterile field.  A small needle is used to place anesthetic on the skin to allow for placement of the RFA probe.  The RFA probe is guided under ultrasound to the targeted nerve.  Once the probe is in the proximity of the nerve, the probe is used to stimulate the nerve.  A patient will feel a buzzing or “heartbeat” thumping depending on the settings.  This stimulus allows me to place the probe as close to the appropriate nerve as possible. Once the probe is confirmed in the exactly appropriate location more anesthetic is delivered to the site of anticipated ablation to make the ablation itself as comfortable as possible.  At this point, the probe is turned on and the ablation begins.  The tip of the probe heats up to 80 degrees Celsius, or 176 Degrees Fahrenheit.  During this stage of the procedure some patients experience pain that eases after about 15-20 seconds.  The nerve or nerves are typically ablated for durations of 60-90 seconds.  The nerve is typically ablated several times in slightly different angles and locations to ensure the best possible result. After all ablations have been performed a post procedure anesthetic block is performed to make the hours immediately after the procedure comfortable.  The foot is wrapped in a light compressive dressing which still typically allows the patient to fit into a tennis shoe. I recommend all my patients take it easy for the next few days. I typically recommend patients have the procedure performed on a Wednesday or Thursday and take the rest of the week off work to rest, ice, elevate and make use of light compression, often an ACE wrap. I recommend Motrin to control pain and swelling after the procedure.  In certain cases I will prescribe a medication specific for nerve related pain for a short duration. I do not find narcotic medication appropriate or necessary provided patients follow aftercare instructions and modify their activities (listen to their bodies). Patients are able to drive themselves home after the procedure, though often patients bring someone with them to drive as much as for moral support.

A patient should consider a reduction in symptoms by 50% after the first procedure a success. In order to achieve a patient’s goals in symptom relief it often takes more than one procedure.  I do not consider attempting a second procedure until at least 10 weeks have passed after the initial procedure. This is because the positive effects of RFA usually take 6-8 weeks to set in. Some patients experience almost immediate relief but this is typically the exception, not the rule.

After 1-2 RFA procedures the overall success rate, which I define as the dramatic reduction in symptoms to a patient’s satisfaction is greater than 80%.

I am fortunate enough to be part of a practice that believes strongly in offering innovative treatments such as RFA.  To date at our practice over 400 procedures have been performed.  200 procedures have been performed in the last two years alone.  Our combined expertise in RFA for the treatment of foot conditions is unmatched in the Pacific Northwest and rivals that of any other facility in the nation.

Along with the expertise that comes from having performed hundreds of procedures, you can expect to be treated with dignity and compassion from start to finish throughout the process.  I will thoroughly evaluate your symptoms, your history and take the time to explain the procedure in detail and answer all your questions to your satisfaction. I will guide you through the procedure itself as well as follow you closely during your recovery.

For more information or to schedule an RFA consultation please visit the following link which will direct you to the office website where I practice:

www.healingfootpain.com

Remember to treat your feet,

-Dr. Robertson