Aktan Çile, Aktan Cemil
Department of Pain Medicine, Antalya Training and Research Hospital, Antalya, Türkiye.
Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Türkiye.
J Foot Ankle Res. 2025 Sep;18(3):e70080. doi: 10.1002/jfa2.70080.
Recalcitrant plantar fasciitis (PF) refers to persistent heel pain lasting ≥ 6 months despite appropriate conservative management, including physical therapy, orthotics, and pharmacological interventions. This study aimed to compare the clinical efficacy and safety of corticosteroid injection (CI), radiofrequency ablation (RFA), and their combination in patients with recalcitrant PF.
In this retrospective study, a total of 156 patients with ultrasonographically confirmed plantar fasciitis, experiencing heel pain for at least 6 months and unresponsive to ≥ 3 months of standard conservative therapy, were included; 52 received RFA, 50 received CI, and 54 underwent combined therapy. Pain intensity (visual analog scale [VAS]), functional status (Foot Function Index [FFI], Roles and Maudsley score [RMS]), plantar fascia thickness (PFT), and relapse rates at 12 months were assessed. Within-group and between-group differences were assessed using appropriate nonparametric tests, and relapse rates were compared accordingly.
All treatment modalities improved VAS, FFI, RMS, and PFT at 6 months (p < 0.001). VAS declined from 6.73 to 6.81 at baseline to 1.62 in the RFA group and 1.83 in the combined group, whereas remaining at 6.56 in the CI group. FFI dropped from ∼52 to 21.50 and 17.57 in the RFA and combined groups but remained at 46.62 in the CI. PFT decreased from ∼6.2 mm to 3.29, 2.71, and 2.95 mm, respectively. Relapse occurred in 12 (23.1%), 19 (38.0%), and 8 (14.8%) patients in the RFA, CI, and combined groups. Between-group differences were significant at 6 months (p < 0.001). No major adverse events were observed.
Both CI and RFA are effective in recalcitrant PF, but their combination provides superior and more durable improvements in pain, function, and fascia morphology, with the lowest relapse rates. Ultrasound-guided combined therapy suggests a safe, practical, and effective treatment option for patients unresponsive to conservative measures.
顽固性足底筋膜炎（PF）是指尽管进行了适当的保守治疗，包括物理治疗、矫形器和药物干预，但足跟疼痛仍持续≥6个月。本研究旨在比较皮质类固醇注射（CI）、射频消融（RFA）及其联合应用对顽固性PF患者的临床疗效和安全性。
在这项回顾性研究中，纳入了156例经超声确诊为足底筋膜炎、足跟疼痛至少6个月且对≥3个月的标准保守治疗无反应的患者；52例接受RFA治疗，50例接受CI治疗，54例接受联合治疗。评估疼痛强度（视觉模拟量表[VAS]）、功能状态（足部功能指数[FFI]、角色与莫兹利评分[RMS]）、足底筋膜厚度（PFT）以及12个月时的复发率。使用适当的非参数检验评估组内和组间差异，并相应比较复发率。
所有治疗方式在6个月时均改善了VAS、FFI、RMS和PFT（p<0.001）。RFA组VAS从基线时的6.73降至6.81，联合组降至1.62，而CI组仍为6.56。RFA组和联合组的FFI从约52降至21.50和17.57，而CI组仍为46.62。PFT分别从约6.2mm降至3.29、2.71和2.95mm。RFA组、CI组和联合组分别有12例（23.1%）、19例（38.0%）和8例（14.8%）患者复发。组间差异在6个月时具有统计学意义（p<0.001）。未观察到重大不良事件。
CI和RFA对顽固性PF均有效，但联合应用在疼痛、功能和筋膜形态方面提供了更优且更持久的改善，复发率最低。超声引导下的联合治疗为对保守措施无反应的患者提供了一种安全、实用且有效的治疗选择。
