Radiofrequency Ablation (RFA)
Radiofrequency Ablation, or RFA, for short, is a non-surgical procedure which ablates, or disables, painful nerve signals. RFA uses the energy to generate heat in a very precise, targeted area. This is a technology which has many medical applications, including back/spine pain, cardiac arrhythmias and destruction of tumors. In the foot and ankle, common conditions that can be treated with RFA are:
- Neuromas (Morton’s Neuroma)
- Heel pain related to plantar fasciitis or neuritis (Baxter’s neuritis, medial calcaneal nerve neuritis)
- Nerve entrapment (when nerves get pinched, often from scar tissue related to previous surgery).
When should one consider RFA?
A patient might consider RFA if they have tried conservative treatments (things like cortisone injections, padding, orthotics, NSAIDs, etc) and failed to achieve adequate relief of their symptoms. RFA should be considered as an alternative option to surgery.
Advantages of RFA over surgery:
- The procedure is non-surgical, meaning: no incisions, no stitches and no wound care is involved.
- The procedure is performed in a comfortable office setting.
- No post procedure weight bearing restrictions (no need for crutches, cast or boot)
- No need for anesthesia other than local anesthetics.
- Patients typically do not need to take time off work.
- Clinical evidence supports RFA as a safe and effective alternative to surgery.
How the procedure works:
The process itself involves placing a probe into the area of the foot which is affected. This is similar to an injection. The probe is moved and the proper placement of the probe is confirmed visually with ultrasound as well as through stimulus from the probe. When the probe is placed near a nerve it can be tested which will create a buzzing on or thumping sensation which informs the doctor that the probe is in the right place. Once placement is confirmed, local anesthetic is injected and the RFA probe turned on to ablate the nerve/tissue by generating heat. While local anesthetic is used to minimize discomfort, this portion of the procedure can be painful, usually for less than 20 seconds.
After the procedure:
A small dressing, brace or ace wrap may be placed on the treated foot immediately after the procedure. Patients can typically fit into an athletic shoe and not need a surgical shoe. The dressing is mainly used to control swelling and only worn the first day. There are no open wounds or incisions, just small pin sized puncture points from the insertion of the needle, similar to what you would get from a regular injection… After the first day, a patient resumes activity to tolerance with an emphasis on RICE (rest, ice, compressive ace wrap, and elevation). Most patients control pain with Motrin or Tylenol. Narcotics are not typically needed nor prescribed.
How long does RFA take to work?
Pain relief is typically not instant. In fact, pain can get a little worse before it gets better. Relief can occur in a matter of days but it usually occurs around weeks 6-8, though this can vary based on the individual. Typically patients note that their nerve pain is lessened immediately after the procedure but is replaced by a different type of pain, usually a soreness, which is caused from the procedure itself.
What kind of results are typical?
RFA usually requires more than one procedure to achieve maximal benefit. Typically, patients note about a 50% reduction in symptoms after the first procedure. Around 80% of patients who have had two procedures are satisfied with their symptom relief.
How long does RFA last?
It is important to note that RFA typically does not result in permanent destruction of the nerve. In some ways RFA can be thought of as “resetting” the nerve, almost like a defibrillator resets a dangerous heart rhythm. While nerve will typically regenerate after 6 months to a year, the nerve does not usually return with pain. Long term relief from the procedure can last in the range from 6 months to several years. In our practice, most patients have sustained relief lasting over two years. Many of our patients have never had their symptoms return since their procedure 4-5 years ago. If pain does return it is usually not as bad as it was originally and another RFA procedure can be performed if needed. It is important to note that most patients (~80%) will need more than one procedure to achieve desired relief.
Can I still have surgery if I have an RFA procedure?
Yes. If a patient elects to have surgery for their condition later they can still do so. RFA does not take surgery “off the table”.
Why Choose Valley Foot and Ankle for your RFA procedure?
Valley Foot and Ankle is the leader in RFA for conditions of the foot. Our doctors, Dr. Mishalanie, Dr. Robertson and Dr. Carlis have nearly a decade of combined experience with the procedure, and have performed over 400 RFA procedures in the past two years alone. Their experience is second to none in the Pacific Northwest and rivals that of any other facility nationwide. Our caring doctors take the time to carefully evaluate your condition, explain the procedure in detail, answer all of your questions before the procedure as well as guide you through the procedure itself and follow up with you at three, six and twelve weeks and beyond. From start to finish you can expect to be treated like family at Valley Foot and Ankle!
Take home points regarding RFA for the foot:
- It is a safe and effective alternative to surgery.
- It usually takes more than one procedure to achieve treatment goals.
- Symptoms are usually reduced, not eliminated.
- As opposed to surgery, there is no risk of a “stump neuroma” when treating a neuroma with RFA.
- It usually takes at least 6-8 weeks to note improvement after RFA.
- RFA is considered “off label”* for use in the foot and is not covered by insurance.
*While RFA is considered “off-label” in the foot, there is extensive clinical data that supports its safety and efficacy in treating conditions of the foot and ankle.