Home > Run Training > Radio Frequency Ablation- Plantar Fasciitis Treatment

Radio Frequency Ablation- Plantar Fasciitis Treatment

July 20th, 2009

After one of the most disappointing seasons of my 19-year running career, I decided to look into more drastic forms of treatment for the plantar fasciitis I’ve been tolerating for close to 4 years. I have become a pro at taping and icing. I have had 2 different sets of custom orthotics (and a couple over the counter pairs), 3 rounds of Shock Wave Therapy (3 sessions for each round) from ’07-’09, 2 shots of a light steroid with an anti-inflammatory, religious usage of the Strassburg Sock and countless massages. What else could I do? Surgery?

The Plantar Fasciitis began affecting other parts of my body last year. For example, I got a stress fracture in my 4th metatarsal in late March of ’08, (perfect timing for my Olympic berth goal) due to overcompensating. I had also been struggling with tight hamstrings and a sore knee since February of 2009. This put me in a difficult situation once track came around. My goal since 8th grade has always been to make a US team. After a successful 2008 season (6th at the Olympic Trials- yes, even after the stress fracture and 5 weeks in the pool), I felt that my shot of making the US team traveling to Berlin was tangible. But, with the extra pain I was experiencing during every run, my coach had to tweak my workouts. I never achieved the sharpness that I needed to be competitive at the USA Track and Field Championships in Eugene. Sure, I made the final of the steeplechase, but I was nowhere near striking distance.

I found that there were options that I hadn’t considered- options other than surgery. A friend told me about Platelet Derived Growth Therapy, which is pretty expensive and still in its infancy. The other procedure I learned about was Radio Frequency Ablation (RFA). After speaking with my coach, Joe Rubio, and few doctors, I chose the RFA route. This was the least evasive and less expensive option of the three. I figured that since I probably spent about as much purchasing tape and other items for treatment, the $400-$600 that the RFA procedure would cost was about the same amount. Besides, what did I have to lose?

Dr. Richie at the Seal Beach Podiatry Group is one of the first doctors to use radiofrequency to treat Plantar Fasciitis. I saw him on Tuesday, July 14th. He has had an 80% success rate, so the odds of a successful procedure are in my favor. Dr. Richie did inform me that RFA would not alleviate 100% of the pain, but a good 90%. I think I can live with the extra 10%.

RF Therapy uses radiofrequency energy to disrupt nerve function. When this is done to a peripheral nerve, such as that found in the foot, the nerve can no longer transmit pain from the site. The nerves that are treated with RFA are not permanently damaged, however. A local anesthetic was applied to my heel, and then a needle about 3 inches or so was inserted into the side of my heel. A probe was then inserted into the needle, which transmits radiofrequency heat (like microwave heat) to the tip that ultimately damages the nerve. This procedure was repeated in three different places in my heel.

The third part in my heel was a bit tricky for Dr. Richie. He had to reinsert the needle into my heel. The problem was that he couldn’t get the needle in easily, due to the rigidity and thickness of my fascia. Eight years of steeplechasing and landing on my (preferred) right foot had caused a lot of scar tissue to develop. I wasn’t in any pain, but watching him trying to insert the needle was disturbing. I could feel the pressure and I could see the struggle and I wanted to say, “Forget it. I don’t need the last shot.”

I won’t know if the procedure is successful for another week or so. My foot is still a little tender five days later, but I have complete faith that Dr. Richie’s talent will allow me to be the runner I was last year… and the competitor I know I can be on the International level for years to come. It’s hard to feel the love for something you have had so much passion for when every step is painful. I think I’m on the right track to feeling that love again and that RFA was the better decision.

Check back for an update next week.

Joe Run Training , , , , , , , , , , , , , ,

  • Glorybelle

    Hi Kara, I just found this blog site… I didn’t know runningwarehouse.com actually had a blog. Very cool.
    I didn’t realize you were having some serious trials and tribulations. I’m sorry to hear about the rough times you’ve been going through. I’ll keep my fingers crossed and send up a few prayers that the RFA treatment is successful. I don’t know if I would be brave enough to watch the doctor put that needle in to my foot. You are one tough lady! Anyway, keep the faith. :) And thanks for sharing this information because it’s very helpful.

  • http://www.runningwarehouse.com Kara

    Thanks, Glorybelle. I appreciate the kind words and hope you are well.

    Update: It’s been just over two weeks since the RFA treatment and my coach and I have decided to postpone running for another two to four weeks. =( My heel is feeling the best it has felt in years, although I’m not sure if it’s due to the treatment or not running for 4 weeks- or a combo of both.

    I’ve been aqua jogging and using the elliptical in our gym at work, as well as lifting weights daily. I’m hoping that 6-8 weeks off of running won’t be too difficult to come back from since I’m cross-training a ton. Cross-country season is just around the corner! Unfortunately, I don’t have access to an Alter-G treadmill. Those things are amazing!

    Things are looking good thus far and I’m keeping my fingers crossed for a positive outcome.

  • http://www.riversedgestyle.com Juanita Day

    Hello Kara–I have had a terrible time with plantar fascitis. I have had injections in the past and I have been using a new orthotic for about 3 months. I am considering ablation. Are you still experiencing a positive result? Have you started running again? I am not a runner but I am a nurse and on my feet a great deal. The fascitis is so debilitating that I can not really tolerate standing, walking etc. for more than short periods of time. I am looking for a long term fix and hope that ablation may be the answer.

  • http://runningwarehouse.com Kara

    @Juanita Day
    Hi Juanita. Thanks for the comment. I am still experiencing positive results. I took 4 weeks of entirely from running after the procedure. Before that, I took 2 weeks off. I went on my first run yesterday! 20 minutes of running without pain is a feeling I haven’t experienced in years!!! I am very excited with the results thus far. I am coming back slowly though, just to be safe. My next run is tomorrow- another 20 minutes, followed by 25 minutes on Saturday.
    I think that because RFA is the least evasive treatment for plantar fasciitis (after orthotics, icing, anti-inflams, etc.), it is something you should consider. You will not be advised to stay off you feet, so you can go to work right after if you wanted. Dr. Richie did suggest time off from running and limited time on my feet for a few days. Since you’re a nurse, you may want to schedule the procedure for a time when you have a couple days off after. I only felt tenderness after the procedure for about 5 days. After that, walking around was significantly more pleasant. If you decide to take the RFA route, I believe you will feel a positive difference. Good luck and if you have any questions, please don’t hesitate to ask!

  • http://www.shapeitup.com Amy Harper

    Kara,
    Thank you for sharing your story! I am a runner and have been struggling with Plantar Fasciatis for over four months now. I have tried everything in the book to recover and nothing has worked. I took a lot of time off from running and tried coming back slowly and am now back to the pain I started with. I cannot get rid of it.
    I am willing to try anything at this point. Are you still having positive results?
    Thank you,
    Amy

  • Jim

    Kara…how’s the running going now? Just curious. Like you, I’ve been battling PF for quite some time. It kind of comes and goes but this last bout never seemed to subside. I’ve taken exactly two months off today. I ordered some new shoes and have been wearing some “heal-that-pain” inserts. They help but I haven’t been running only biking. The foot feels pretty good right now but that’s due to not running. The RFA sounds intriguing. Thanks for sharing your experience.

  • Kara

    Hi Amy and Jim! I am very sorry to hear that you are both suffering from P.F. Not only does it affect running, but it creeps over into everyday life. (As I’m sure you know.) Fortunately, I am still having positive results. I am running 50 minutes, 7 days a week right now, as well as getting on the elliptical 5 days a week for 45 minutes. So, in that sense, running is going really well compared to the 30 minutes a day, 5 days a week that I was doing a couple weeks ago. I have been very cautious about coming back slowly. As my coach, Joe Rubio, has instructed, I’m running “stupid slow” right now. It’s difficult though when my team is racing already!

    I am feeling a touch of pain after my runs, although it’s nothing even close to what I was experiencing before, during and after running prior to the procedure. I’m currently taping before my runs and icing after. I have been informed by Dr. Richie not to get on an anti-inflam regimen, as it will mask any pain and block the RFA from continuing to do its job.

    I’d still recommend the procedure to people who have tried everything with no success. Good luck to both of you and please let me know if you have questions.

  • Matt

    Kara,
    I have a simple question. I too have been battling PF for many months. I had it my left foot 10 years ago but one cortisone knocked it out and it never came back. My right foot however picked up after my last marathon training and it refused to go away, 3 shots later it’s about 75% but still not good enough to run. I’m considering RF treatment but my question is besides stopping the pain do you notice any other loss of sensation? Is your foot numb and how did your doctor tell you to monitor wear and tear? My fear is that the pain I have in my PF is there to tell me slow down, if I can’t feel it anymore will I tear it? That would be worse that surgery. My doctor explained to me that the source of the pain is the nerve itself being pulled and stretch since the fascia is swollen. How are you running now?

  • Kara

    @Matt Hi Matt,

    I never tried the cortisone route myself because my understanding is that there is a greater chance of tearing the plantar fascia and that the cortisone actually weakens the fascia.

    Dr. Richie ensured me that I would not lose any sensation in my heel. He has been correct. I still have all the sensation in my right heel as I do in my left (the good one). My foot was actually only numb for a few hours after the procedure, until the anesthetic wore off. It takes 4-6 weeks for the RF procedure to complete its full effect on the nerve tissue. You have no risk for RFA, but there are no guarantees either. Dr. Richie’s success rate is 80% for over 50 patients, so the chances of success are great.

    After 4 long weeks in the pool and on the elliptical, I ran 3 days for 20 minutes. The following few weeks, I bumped up the time and frequency of my runs. I didn’t feel any pain, but I did take it very slowly. Dr. Richie told me to stop if the pain exceeded 50% of what I was experiencing before the procedure. My coach and I didn’t bump up the intensity until about 4 weeks ago, which was 10 weeks after the procedure. I hit 78 miles last week that included 2 harder workouts and a long run of 90 minutes. Running is going very well at this time, considering where I was a couple months ago. I’ve been advised to run my workouts and races (first one is this weekend!) in shoes that have substance- no spikes and no racing flats for a while. I still tape and started icing once I began running. Stretching is something I’ve let slip, but need to get back on top of.

    Please let me know if you have any further questions or concerns. I hope you find success in treating the PF, as I know how annoying and frustrating it is. Best wishes!

    Kara

  • Matt

    I’m making the appointment to get it done, it’s looks like zero risk, if it doesn’t work I’m no worse off and the nerve will regenerate so I guess you have to have it again and again? Thank you for the advice. Hopefully I’ll be better soon. Best of luck to you.

    Matt

  • Kara

    Hi Matt~ I was told that I may need to come back in a year for another procedure. I’m hoping that the additional year will assist with the plantar healing on its own. Remember to take it easy for 3- 4 weeks after… the longer, the better. I don’t miss my friendship with the elliptical or the pool, but I’m glad they were there for me when I wasn’t running. Best of luck and, if you have the chance, let us know how the procedure goes.

    Kara

  • Matt

    It’s been about 10 days since I got it done and right now I can’t tell a difference. They said it would take some time for the nerve to die (which is exactly what is happening). I don’t know how long it will take but I did hear that the nerve can regenerate and the pain might come back. I’m still sticking to my theory that all it’s doing is masking the pain, the damage is still occurring. I’m not too sure about this but either way the pain has to go away. The doctor assures me that I can’t do any real damage to the fascia and that there are other nerves around who tell me if I’m really messing something up. How is your training going Kara?

    Matt

  • Kara

    Hi Matt,

    I hope you are feeling positive results from the RFA. I can’t remember exactly how long it took until most of the pain went away. I think it may have been 2 to 3 weeks. Everything is feeling great still. I have a teeny, tiny amount of pain, but it’s way tolerable. I don’t believe you’re messing anything up by having the procedure done. If you’re like me, you’d still be running through the pain anyway. RFA makes the pain tolerable. I was told that I may have to return for another procedure after about a year. I hope that’s not the case, but I’d go through it again if it means little to no pain. =)

    Training is going really well! I just ran the PA USATF XC Championships in San Francisco over the weekend. I finished second to an amazing runner, Linda Somers-Smith (teammate and training partner) and only three seconds off last years time. The results of the procedure have enabled me to up my mileage comfortably and to bring intense workouts back into my routine. My team, the Asics Aggies, and I will travel to Lexington, Kentucky for the US Club Cross Country Championships on Dec. 12th. After that, I hope to toe the line on January 17th for the US Half Marathon Championships in Houston. Things are looking positive!!

    Keep us posted if you have the chance. Good luck!!!

    Kara

  • Leona Norton

    I was hesitant to try it but I had RADIOFREQUENCY ABLATION for PLANTAR FOOT PAIN done in early Sept. 2010; at the present I am doing extremely well–IT WORKED!!!… and it made a great difference in my life!
    I want to get the other foot done now.
    I am now living in the midwest and it is difficult to find a doctor who does this procedure.