The Effectiveness of Radiofrequency-Based Percutaneous Microtenotomy (TOPAZ) to Treat Refractory Plantar Fasciitis

Review Article

Austin J Orthopade & Rheumatol.2016; 3(3): 1039.

The Effectiveness of Radiofrequency-Based Percutaneous Microtenotomy (TOPAZ) to Treat Refractory Plantar Fasciitis

Al Bagali M¹, Al Saif M²*, Hashem F² and Sager W²

¹Department of Orthopaedics, Al Kindi Specialised Hospital, Bahrain

²Department of Orthopaedics, Salmaniya Medical Complex, Bahrain

*Corresponding author: Mohammed Al-Saif, Department of Orthopaedics, Al Kindi Specialised Hospital, Bahrain

Received: July 13, 2016; Accepted: September 16, 2016; Published: September 20, 2016


Purpose: To assess the safety and effectiveness of radiofrequency-based percutaneous microtenotomy to treat refractory plantar fasciitis symptoms.

Study type: Prospective, non-randomized single center study.

Methods: The average age of the patients was 47 years old. All the 70 patients enrolled had refractory plantar fasciitis symptoms for more than 6 months duration, before they underwent the surgery between 2006 and 2013. The radiofrequency-based percutaneous microtenotomy was performed using TOPAZ Microdebrider device (ArthroCare, Sunnyvale, CA). Patients were followed-up for 6 months postoperatively. Pain status was recorded using Visual Analog Scale (VAS) pre-and postoperatively and Foot and Ankle Outcome Score (FAOS).

Results: Patients reported significant reduction of pain and improved function from the baseline at 6 weeks post-operatively (P = 0.05). There were no post-operative complications.

Conclusion: Radiofrequency-based microtenotomy appears to be a promising treatment option for refractory plantar fasciitis. This procedure provides a valuable alternative surgical option to those patients.


Approximately 10 % of the population develops planter fasciitis over a lifetime [1]. It is a non-inflammatory, degenerative condition that has been linked to repetitive microtrauma and overuse [2]. Nonsurgical management has often been the more common modality of treatment, including analgesia, rest, foot orthotics and support, physiotherapy, and steroid injection [3]. Its pathology is similar to a tendinosis which is a result of failed tendon healing. Tendinosis is characterized by an absence of inflammatory cells, an abundance of disorganized collagen and fibroblastic hypertrophy, and disorganized vascular hyperplasia with avascular tendon fascicles. Vascular structures are believed to be nonfunctional [4]. Various studies have also suggested that nutritional flow through the affected tendon is compromised, resulting in a difficulty for tenocytes to synthesize the extracellular matrix which is needed for repair and remodeling [5,6]. A principal goal in treatment of tendinosis is to establish a biologic healing response [7]. It has been shown that laser and radiofrequency transmyocardial revascularization can lead to increased localized angiogenesis [8], with improvement in clinical parameters, and better histological and biochemical findings [9,10]. Fibroblastic Growth Factor (FGF), Vascular Endothelial Growth Factor (VEGF), vascularity and vascular cells were all found to be increased [11,12]. The treatment of a tendinosis by a radiofrequency -based approach might therefore be valuable. This option was studied in a pilot clinical studies and pre-clinical research which found that radiofrequency -based microtenotomy was effective in simulating an angiogenic healing response in tendon tissue. Early inflammatory response, neovascularization, elevated VEGF and a-v integrin were all shown [13,14]. Radiofrequency -based microtenotomy was thus started for the treatment of tendinosis, and has been successfully used in the management of conditions such as tennis elbow and rotator cuff tendinosis [15,16]. Improved clinical parameters in the study would include reduced pain and improved function. Improved Visual Analog Scores (VAS) and improved foot and ankle outcome scores would be indicative of a successful intervention. We thus carried out this study to determine the effectiveness of percutaneous microtenotomy using a bipolar Radiofrequency –based probe to treat chronic tendinosis of the plantar fascia. We also aim to look for any potential complications of the procedure.



This was a prospective, nonrandomized single-center clinical study. A total of 70 patients who were diagnosed with plantar fasciitis where enrolled for the study. There were 21 males and 49 females, whose average age was 47 years old (Table 1).