Comparison of Radiofrequency Microtenotomy vs. Heavy-Slow Resistance for Refractory Plantar Fasciopathy: A Randomised Controlled Trial

BACKGROUND: Plantar fasciopathy is the most common cause of plantar heel pain, yet effective interventions for refractory cases remain uncertain. Heavy-slow resistance training and radiofrequency microtenotomy have both been proposed as treatment options, but their comparative efficacy has not been evaluated in a randomised controlled trial. OBJECTIVE: To compare the efficacy of radiofrequency microtenotomy versus heavy-slow resistance training for improving pain in patients with refractory plantar fasciopathy (PF) after 6 months, measured by the Danish version of the Foot Health Status Questionnaire (FHSQ-DK) pain domain. METHODS: This was a randomised controlled superiority trial. Patients with refractory PF were randomly assigned to radiofrequency microtenotomy or a self-dosed heavy-slow resistance training programme. The primary outcome was the change in the pain domain of FHSQ-DK from baseline to the 6-month follow-up. Secondary outcomes included the remaining domains of FHSQ-DK, Global Perceived Effect, sports and activity levels, barriers to training and adverse events. RESULTS: We randomly assigned 82 patients and included 72 patients (74% female) in the final analysis. There was no statistically significant between-group difference in mean change from baseline to 6 months in FHSQ-DK pain (mean difference - 4.9 (95% CI - 13.8; 4.0). There were no between-group differences at any time point in the other domains of the FHSQ-DK, the physical activity questionnaire and Global Perceived Effect (GPE) (P > 0.05), except at 1 month in the ability to perform sports (GPE, P<0.05). No serious adverse events were observed during the trial. Adverse events was reported by four patients in the radiofrequency microtenotomy group and five patients in the heavy-slow resistance training group. CONCLUSION: We found no difference in primary or secondary outcomes between radiofrequency microtenotomy and heavy-slow resistance training at any time point of FHSQ-DK. The findings suggest that a minimally invasive surgical treatment is not superior to performing an exercise intervention in patients with refractory PF. Based on the design and results, radiofrequency microtenotomy should not be recommended over heavy-slow resistance training, as it did not demonstrate superior outcomes. Registration clinicaltrials.gov (NCT03854682).