Inferior Calcaneal Nerve Radiofrequency Ablation for Chronic Heel Pain

Ultrasound-Guided Radiofrequency Ablation of the Inferior Calcaneal Nerve for Chronic Refractory Heel Pain: A Prospective Pilot Study

This prospective single-arm pilot interventional study aims to evaluate the effectiveness of ultrasound-guided radiofrequency ablation of the inferior calcaneal nerve in patients with chronic heel pain refractory to conservative treatments. Patients with plantar fasciitis or calcaneal spur who have not responded to multiple treatment modalities, including exercise, nonsteroidal anti-inflammatory drugs, orthotics, extracorporeal shockwave therapy, and corticosteroid injections, will be included. The procedure will be performed under ultrasound guidance. Pain intensity, functional status, and patient satisfaction will be assessed at baseline and at 1 and 3 months after the intervention. The primary outcome is treatment success, defined as a ≥50% reduction in pain intensity at 1 month compared to baseline.

Chronic heel pain, most commonly caused by plantar fasciitis or calcaneal spur, is a prevalent musculoskeletal condition that can significantly impair daily activities and quality of life. Although most patients respond to conservative treatments, a subset remains symptomatic despite multiple therapeutic interventions. In recent years, interventional procedures targeting peripheral nerve structures have gained increasing attention in the management of chronic musculoskeletal pain.

The inferior calcaneal nerve, a branch of the lateral plantar nerve, provides sensory innervation to the heel region and has been implicated in the pathophysiology of chronic heel pain. Targeting this nerve may offer a focused and potentially effective treatment option in refractory cases.

This study is designed as a prospective, single-arm pilot interventional study conducted at a tertiary rehabilitation center. Adult patients aged 18-75 years with chronic heel pain lasting more than 6 months and refractory to at least four conservative treatment modalities will be consecutively recruited. The intervention consists of ultrasound-guided radiofrequency ablation of the inferior calcaneal nerve.

Clinical outcomes will be evaluated using the Numeric Rating Scale (NRS) for pain, Foot Function Index (FFI), Roles and Maudsley score, and a 5-point Likert patient satisfaction scale at baseline and during follow-up at 1 and 3 months. Treatment success will be defined as a ≥50% reduction in pain intensity at 1 month, while a ≥80% reduction will be considered marked improvement. In addition, the sustainability of treatment effects will be assessed at 3 months. Procedure-related adverse events will also be recorded.

The findings of this study are expected to provide preliminary evidence regarding the effectiveness and safety of inferior calcaneal nerve radiofrequency ablation in patients with chronic refractory heel pain and may inform the design of future larger-scale studies.

Inclusion Criteria:

• Age between 18 and 75 years
• Chronic heel pain lasting longer than 6 months
• Clinical (tenderness and/or pain at the medial calcaneal tubercle) and radiological (X-ray or ultrasound) diagnosis of plantar fasciitis or calcaneal spur
• Refractory to at least four conservative treatment modalities, including exercise therapy, orthotic support (silicone heel pad), nonsteroidal anti-inflammatory drugs, extracorporeal shockwave therapy, and/or corticosteroid injection

Exclusion Criteria:

• History of trauma to the foot or ankle
• History of foot or ankle surgery
• Presence of systemic inflammatory disease
• Presence of peripheral neuropathy or S1 radiculopathy
• Pregnancy
• Hemodynamic instability
• Presence of skin or soft tissue infection at the injection site
• Refusal to participate in the study