New Techniques Update: Coblation for the Treatment of Plantar Fasciosis

Lowell Scott Weil, Sr., DPM, FACFAS

Correspondence: On November 6, 2006, The Foot Blog© reported on a NIH study head by Dr. Scott Weil , DPM on the treatment of plantar fasciosis using the Arthrocare Topaz™ Microdebrider™. The report was entitled “Coblation Technique in the Treatment of Plantar Fasciosis“. This is a phase IV study beginning in August 2005 and ending in February 2007. The study is funded and sponsored by the ArthroCare Corporation. They are the makers of the ArthroCare TOPAZ™ MicroDebrider™.

It’s been a year since the completion of this study, so we contacted Dr. Weil recently on the results of the study:

Q: Dr. Weil, what principal findings did your group conclude from the coblation study?

A: The Weil Foot & Ankle Institute Research Foundation has previously performed clinical research on the results of Percutaneous Plantar Fasciotomy (PPF), Extracorporeal Shock Wave Treatment (ESWT), and most recently:
Phase 1 of a Randomized, Double Blind, Placebo Controlled study that compared an “open” plantar fasciotomy to an “open” Micro fasciotomy using the Topaz MicroDebrider. The results supported the hypotheses that “A Plantar Fasciotomy sparing procedure, the TOPAZ Microfasciotomy, is as effective as “open” plantar fasciotomy in the treatment of chronic plantar fasciitis”. All subjects had treated, chronic plantar fasciitis for more than 6 months and pain scales of 6/10 upon first steps in the morning.

Phase 2 is ongoing with the hypotheses “Percutaneous K-Wire Puncture followed by multiple RF TOPAZ COBLATION (Arthrocare) was as effective as Percutaneous Plantar Fasciotomy and Resulted in Less Pain and Disability”. The results of this study should be completed in the next three months.

Q. Will your group be presenting the results to any journals in the near future?

A: Yes, of course. The procedure is very much technique dependent and we hope to present the results as well as the advised technique in the near future. A video has been produced but we will not release it until the completion of the study and validation of the data.

Q: Do you consider this technique viable with advantages over the endoscopic plantar fascial release or autologous blood injection?

A: Basically, the results of PPF, instep fasciotomy (IF), and endoscopic plantar fasciotomy (EPF) are virtually the same. Our Phase one results were comparable to these other procedures with the one caveat that The TOPAZ procedure did not section the plantar fascia as compared to the other procedures mentioned. As part of the study, computerized footprint analysis was also performed to evaluate the change in foot function after sectioning of a portion of the plantar fascia (EPF, PPF, and IF) as well as the change after the TOPAZ micro fasciotomy. There is no question that the TOPAZ procedure is viable but the final data comparing return to activities of daily living (ADL) between the procedures, will be very important to surgeons vying for good results while having a rapid recovery with few complications.

Autologous blood injections are still undergoing double blind, clinical studies for chronic plantar fasciitis. The reader must carefully look at the design of the various studies to determine the validity of the results.

Q: Do you see any promising new treatment modalities in the future in the area of treating plantar fasciitis and fasciosis?

A: Yes. As with any procedure, there are failures that must be continually treated. Within a month, we will begin Randomized and Single Blinded clinical trials on the use of the Podiatherm (Neurotherm) for the treatment of FAILED plantar fascia surgery or ESWT. This should be quite interesting and hopefully complete the circuit of available modalities for the treatment of unresponsive, chronic, plantar fasciitis. We still believe that 84% of the patients may be successfully treated with standard podiatric medical and mechanical means for the resolution of plantar fasciitis.

Thank you, Dr. Weil, for your time.

© The Foot & Ankle Journal

3 responses to “New Techniques Update: Coblation for the Treatment of Plantar Fasciosis

  1. steven h goldstein

    After reading the comments of Dr. Weil, there was no mention of another effective way to treat chronic plantar fasciitis. The use of cryoablation has been used since 2003 with close to 5000 cases over 100 cryosurgeons about the country. The overall success rates range between 80-93 percent. A study is presently going on in california soon to be submitted for publication. Freezing of the medial calcaneal nerve has been extremely effective in treating chronic plantar fasciitis

  2. Dr. Goldstein,

    While this correspondence only inquired about the NIH study funded by Arthrocare, the use of cryotherapy has been thorouly reported in the literature. I site the most recent article written by Drs.Allen, Fallat & Schwartz in the March/April 2007 issue of JFAS entitled “Cryosurgery: An Innovative Technique for the Treatment of Plantar Fasciitis.” (JFAS 46:2)

    In their study, 59 patients (61 heels) underwent “percutaneous denervation” using a cryoprobe. In this study, however, the probe was inserted in the site of “maximal tenderness” and not to any specific nerve. They do state in the discussion that “the cryotherapy is used to destroy the branches of the medial calcaneal nerve that innervate the fascia and register pain.” They also “postulate that inflammation along the plantar fascia is being destroyed as well”. They found this technique to be beneficial with results similar to that of plantar fasciotomy, but with fewer cost and complication such as lateral column destabilization.

    In December 2006, I wrote an article for the foot blog entitled “Historical Review: Surgical Release of the First Branch of the Lateral Plantar Nerve for Chronic Heel Pain“. This technique had been reported in the literature for quite some time.

    In 1989, Baxter and Pfeffer reported surgical neurolysis results obtained on 69 heels (fifty-three patients) with chronic heel pain. The average duration of heel-pain symptoms were 23 months (range 6months to 8 years). They reported that 61 heels (89%) had excellent or good results and 57 heels (83%) had complete resolution of pain symptoms.

    In 2000, Stephen Tillett DPM and Terry Kennedy DPM reported on 12 heels (11 patients) that underwent neurolysis of the first branch of the lateral plantar nerve. The patient’s average duration of heel-pain symptoms was 19 months (range 3 months to 60 months). Post-operatively all twelve heels were deemed as a excellent or good result with eight patients relating 100% relief of pain on an average of 4.1 months (range 8 weeks – 11 months), and the other four patients relating 80% or better improvement.

    Most studies focused on the first branch of the lateral plantar nerve, and not the medial calcaneal nerve. The branches of the medial calcaneal nerve innervate the heel more posterior than most areas of focal tenderness seen in medial plantar fascitis or fasciosis.

    The results of your study should be very interesting and highlight much needed data and understanding of this frustrating condition.

    ~Al Kline DPM