• 1

    Bardelli M, Turelli L, Scoccianti G: Definition and classification of metatarsalgia. Foot Ankle Surg 9: 79, 2003.

  • 2

    Arie EK, Moreira NS, Freire GS, et al: Study of the metatarsal formula in patient with primary metatarsalgia. Rev Bras Ortop 50: 438, 2015.

  • 3

    Espinosa N, Brodsky JW, Maceira E: Metatarsalgia. J Am Acad Orthop Surg 18: 474, 2010.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 4

    Barouk P: Recurrent metatarsalgia. Foot Ankle Clin 19: 407, 2014.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 5

    Cosman ER Jr, Cosman ER Sr: Electric and thermal field effects in tissue around radiofrequency electrodes. Pain Med 6: 405, 2005.

  • 6

    Chen LC, Ho CW, Sun CH, et al: Ultrasound-guided pulsed radiofrequency for carpal tunnel syndrome: a single-blinded randomized controlled study. PLoS One 10: e0129918, 2015.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 7

    Wu YT, Ho CW, Chen YL, et al: Ultrasound-guided pulsed radiofrequency stimulation of the suprascapular nerve for adhesive capsulitis: a prospective, randomized, controlled trial. Anesth Analg 119: 686, 2014.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 8

    Chon JY, Hahn YJ, Sung CH, et al: Pulsed radiofrequency under ultrasound guidance for the tarsal tunnel syndrome: two case reports. J Anesth 28: 924, 2014.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 9

    Wu YT, Chang CY, Chou YC, et al: Ultrasound-guided pulsed radiofrequency stimulation of posterior tibial nerve: a potential novel intervention for recalcitrant plantar fasciitis. Arch Phys Med Rehabil 98: 964, 2017.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 10

    Tallia AF, Cardone DA: Diagnostic and therapeutic injection of the ankle and foot. Am Fam Physician 68: 1356, 2003.

  • 11

    Wassef MR: Posterior tibial nerve block. A new approach using the bony landmark of the sustentaculum tali. Anaesthesia 46: 841, 1991.

  • 12

    Arai YC, Nishihara M, Aono S, et al: Pulsed radiofrequency treatment within brachial plexus for the management of intractable neoplastic plexopathic pain. J Anesth 27: 298, 2013.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 13

    Akkaya T, Ozkan D: Ultrasound-guided pulsed radiofrequency treatment of the intercostal nerve: three cases. J Anesth 27: 968, 2013.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 14

    Nader A, Bendok BR, Prine JJ, et al: Ultrasound-guided pulsed radiofrequency application via the pterygopalatine fossa: a practical approach to treat refractory trigeminal neuralgia. Pain Physician 18: E411, 2015.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    E Djibilian Fucci R, Pascual-Ramírez J, Martínez-Marcos A, et al: Ultrasound-guided sciatic nerve pulsed radiofrequency for chronic knee pain treatment: a novel approach. J Anesth 27: 935, 2013.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 16

    Ozkan D, Akkaya T, Yildiz S, et al: Ultrasound-guided pulsed radiofrequency treatment of the pudendal nerve in chronic pelvic pain. Anaesthesist 65: 134, 2016.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 17

    Hamann W, Abou-Sherif S, Thompson S, et al: Pulsed radiofrequency applied to dorsal root ganglia causes a selective increase in ATF3 in small neurons. Eur J Pain 10: 171, 2006.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Van Zundert J, de Louw AJ, Joosten EA, et al: Pulsed and continuous radiofrequency current adjacent to the cervical dorsal root ganglion of the rat induces late cellular activity in the dorsal horn. Anesthesiology 102: 125, 2005.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Efficacy of Ultrasound-Guided Pulsed Radiofrequency for Recalcitrant Metatarsalgia

A Case Report

Tsung-Yen Ho Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, 11490 Taipei, Taiwan.

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Ming-Jen Ke Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, 11490 Taipei, Taiwan.

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Liang-Cheng Chen Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, 11490 Taipei, Taiwan.

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Yung-Tsan Wu Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, 11490 Taipei, Taiwan.

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Metatarsalgia is characterized by pain in the forefoot, which is associated with increased stress over the metatarsal head region. Despite the availability of a variety of conservative or surgical treatments for this condition, a few cases have demonstrated relapse or poor response to treatment. Pulsed radiofrequency (PRF) can provide pain relief in patients with diverse chronic conditions without causing neural injury. Recently, studies have shown that ultrasound-guided PRF may be beneficial for adhesive capsulitis, carpal tunnel syndrome, tarsal tunnel syndrome, and recalcitrant plantar fasciitis. Here, we describe a successful case of significant pain relief achieved by using ultrasound-guided PRF targeting the posterior tibial nerve (PTN) at the ankle of a 67-year-old woman with recalcitrant metatarsalgia. Ten minutes after ultrasound-guided PRF was applied at the PTN, the patient reported decreased pain (from 8 to 3 on a visual analogue scale) and did not exhibit any particular side effects. Three months after PRF application, the patient's visual analogue scale score remained more than 50% below the baseline, and she did not need additional conservative treatment during the follow-up period. To the best of our knowledge, we present the first case report using ultrasound-guided PRF at the PTN for treatment of recalcitrant metatarsalgia. We hypothesize that ultrasound-guided PRF at the PTN may be a potentially novel approach for treating recalcitrant metatarsalgia.

Corresponding author: Yung-Tsan Wu, MD, Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No 325, Sec 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan. (E-mail: crwu98@gmail.com)