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Percutaneous Micro-Fasciotomy using Plasma
Ablation for the Treatment of Plantar Fasciosis
A Randomized, Controlled, Double-Blind Study,
Comparing the Results with Percutaneous Plantar
Fasciotomy Shine John, DPM, Lowell Scott Weil,
Sr. DPM, FACFAS, Lowell Weil, Jr. DPM, MBA,
FACFAS, Anthony H. Borrelli, DPM, FACFAS, Gregory
Amarantos, DPM, FACFAS, Wendy Benton-Weil, DPM,
FACFAS, Robert Fridman, DPM, AACFAS, Jarrett
Cain, DPM, Jason Glover, DPM Weil Foot and Ankle
Institute, Des Plaines, Il. www.weil4feet.com
RESULTS
BACKGROUND
DATA /TABLES
Table 1. Patient Demographics and Use of
Conservative Care Measures
The use of plasma ablation, microtenotomy is
becoming well established for treating chronic
tendinopathy in the knee, elbow and
shoulder(1-5). Recently, this technology has
been applied to the treatment of chronic foot and
ankle pathology as well, including plantar
fasciosis, Achilles and posterior tibial
tendinosis. The purpose of this study was to
evaluate the effectiveness of plasma RF-based
microfasciotomy (P-RF-MF) for relieving pain
associated with recalcitrant plantar fasciosis
and, secondarily, to determine whether additional
benefits, such as reduced incidence of
postoperative complications and improved
function, were observed compared to conventional
surgical technique using percutaneous plantar
fasciotomy (PPF).

• Pain associated with the surgical incision was
  the most important and commonly observed
  significant clinical event. This necessitated a
  protocol change that reduced this clinical event
  in both surgical groups.
• Demographics of surgical groups were
  statistically similar (Table 1). Patients from
  both groups had an average age of approximately
  48, mean BMI of 30, and the 2 of 3 patients were
  female. The conservative care measures taken
  prior to considering surgical intervention were
  also similar for both treatment groups. Over 80
  of patients from both groups had found it
  necessary to modify their physical activities,
  and had tried orthotics, received at least one
  steroid injection, and used NSAIDs regularly.
• Both surgical groups demonstrated significant
  improvement in post-operative function scores, as
  measured using the Ankle-Hindfoot Index score and
  Roles and Maudsley score, and significantly
  reduced pain scores, as measured using the visual
  analogue scale (VAS) score, post-operatively
  (Table 2 Table 3). Pre- and post-operative
  function and pain scores did not differ
  significantly between treatment groups. At 6
  months, approximately two-thirds of patients in
  both surgical groups had good or excellent Roles
  and Maudsley score.
• Quality of life (SF-36) scores were statistically
  similar for both surgical groups pre- and
  post-operatively. At 6 months, both groups
  demonstrated significantly (plt0.05) improved
  quality of life for most SF-36 components and
  scores fell within the normative standard for all
  components.
• The proportion of patients satisfied with each
  surgical procedure at 3 and 6 months
  post-operatively was also statistically similar.
  At 6 months, 80 of patients were satisfied with
  the surgical procedure they had received.

MATERIALS AND METHODS
Table 2. Postoperative Change in AHI and Pain
VAS Scores
Table 3. Pre- and Post-operative Roles and
Maudsley Scores
Patients with chronic, refractory plantar
fasciosis treated unsuccessfully using
conservative care measures and whose next option
was surgery, were approached to participate in
the study. Computerized, random assignment into
a surgical group of PPF or P-RF-MF took place
during the surgery with both patients and the
podiatric physicians conducting the follow-up
examinations blinded to treatment. The primary
endpoint for patient evaluation is 3 months with
a majority of follow-ups carried out to
approximately 1 year. Inter-study protocol
changes necessitated a dual report on secondary
outcome measures. Clinical evaluation measures
included ankle-hindfoot index score, visual
analogue scale (VAS) pain score, SF-36 quality of
life assessment, Roles and Maudsley score, and
patient satisfaction. The continuous variables
were tested for normality and equal variance
prior to parametric statistical analyses. If
normality and equal variance are achieved, then
parametric analyses (Students t-test) were
performed. If normality is not achieved, then a
non-parametric test (Wilcoxon test) was applied.
Categorical variables were analyzed using the
Fishers exact test or Chi-square
test as appropriate. A minimum significance
level of p0.05 was used for all statistical
tests.
DISCUSSION AND CONCLUSIONS
Micro-fasciotomy performed using plasma ablation
appears to provide equally successful clinical
results as plantar fasciotomy while sparing
severing of the plantar fascia. Following
protocol changes to MIS (minimally invasive
surgery) for both techniques, early observations
appear to suggest that subjects undergoing
P-RF-PF based micro-fasciotomy returned to ADL
(activities of daily living) more quickly than
those subjects undergoing PPF.

• Pulsed radiofrequency applied to the
  suprascapular nerve in painful cuff tear
  arthropathy. Kane TP, Rogers P, Hazelgrove J,
  Wimsey S, Harper GD. J Shoulder Elbow Surg. 2008
  May-Jun17(3)436-40.
• Radiofrequency microtenotomy a promising method
  for treatment of recalcitrant lateral
  epicondylitis. Meknas K, Odden-Miland A, Mercer
  JB, Castillejo M, Johansen O. Am J Sports Med.
  2008 Oct36(10)1960-5.
• Radiofrequency-based plasma microtenotomy
  compared with arthroscopic subacromial
  decompression yields equivalent outcomes for
  rotator cuff tendinosis. Taverna E, Battistella
  F, Sansone V, Perfetti C, Tasto JP. Arthroscopy.
  2007 Oct23(10)1042-51.
• Microtenotomy using a radiofrequency probe to
  treat lateral epicondylitis. Tasto JP, Cummings
  J, Medlock V, Hardesty R, Amiel D. Arthroscopy.
  2005 Jul21(7)851-60.
• Meniscal debridement with an arthroscopic
  radiofrequency wand versus an arthroscopic
  shaver comparative effects on menisci and
  underlying articular cartilage. Allen RT, Tasto
  JP, Cummings J, Robertson CM, Amiel D.
  Arthroscopy. 2006 Apr22(4)385-93.

A difference between 4-6 weeks and preoperative
scores B statistical significance (at plt0.05) of
the change between the 4-6 weeks scores and
preoperative scores