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Background Plantar fasciitis, a condition marked by persistent and often excruciating heel pain, frequently poses a formidable hurdle when conservative treatment approaches fall short. This multi-centered retrospective study embarks on a journey to explore the potential effectiveness of pulsed radiofrequency nerve ablation (RFNA), an innovative and less invasive procedure, as a novel avenue for treating recalcitrant plantar fasciitis. This investigation centers around a group of 24 patients who have faced the persistence of this challenging ailment. By meticulously scrutinizing patient outcomes and conducting a comprehensive analysis of safety aspects, this study aspires to offer enlightening revelations regarding the promise and practicality of pulsed RFNA as a therapeutic solution for tackling this intricate and tenacious condition. Methods This retrospective study included 24 patients who had undergone pulsed RFNA for recalcitrant plantar fasciitis between June 1, 2020, and June 1, 2022, at Hospital Pengajar Universiti Putra Malaysia (HPUPM), Hospital Universiti Teknologi Mara (UiTM), and Hospital Serdang. Patients were selected from the Orthopedic Clinics at HPUPM, Hospital UiTM, and Hospital Serdang and were screened according to the inclusion and exclusion criteria. Patient data was extracted from the hospital information system and electronic medical records. Pre-procedure and post-procedure assessments were conducted at one, three, and six months on the selected patients using the visual analog scale and American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scoring systems. All selected patient data was traced and tabulated accordingly. Results This study evaluates the effectiveness of pulsed RFNA in treating recalcitrant plantar fasciitis in 24 participants (39 feet). Results show a significant reduction in pain and improvement in functionality at one, three, and six months post-RFNA. Demographic factors (age, gender, and specific diagnosis) did not significantly impact outcomes. The study supports pulsed RFNA as an effective treatment for recalcitrant plantar fasciitis, emphasizing consistent benefits across various patient characteristics. Conclusion In conclusion, the study demonstrates the notable effectiveness of pulsed RFNA in improving pain reduction and functional outcomes for individuals with recalcitrant plantar fasciitis. The findings, consistent across various demographic factors, support pulsed RFNA as a promising and uniform treatment option for those who do not respond to conservative measures.
RESUMO
BACKGROUND Tarlov cysts are rare, with a prevalence of 3.3% in the Asian population, and symptomatic cases are even rarer. Here, we report a case of a young woman with multiple Tarlov cysts presenting in primary care with severe low back pain. CASE REPORT A 23-year-old Malay woman presented to a primary care clinic with sudden-onset, severe, and persistent low back pain for 1 week, affecting her activities of daily living (ADL), especially as a medical student, as she could not stand for more than 10 minutes. There were no other associated symptoms or recent trauma prior to the onset of back pain. Examinations revealed para-vertebrae muscle tenderness and restricted movements at the L4/L5 lumbosacral spine. A plain radiograph of the lumbosacral spine showed sclerosis and erosion of the right pedicle at the L4/L5 levels. Tuberculosis and haematological tests were normal. A lumbosacral MRI of the spine was ordered and the patient was urgently referred to the orthopaedic spine team. The MRI confirmed the diagnosis of multiple Tarlov cysts, with the dominant cyst located at the S2 level. Her symptoms and ADL improved with conservative management. She is being monitored closely by the orthopaedic team and primary care physician. CONCLUSIONS This case highlights red flag symptoms, ie, sudden-onset, severe, and persistent low back pain, that warrant further investigation. Tarlov cysts should be considered as a differential diagnosis. Close monitoring is vital and early surgical intervention is indicated if symptoms worsen, to prevent potential irreversible nerve damage.
