Abstract
BACKGROUND: Recalcitrant plantar fasciitis (PF) refers to persistent heel pain lasting ≥ 6 months despite appropriate conservative management, including physical therapy, orthotics, and pharmacological interventions. This study aimed to compare the clinical efficacy and safety of corticosteroid injection (CI), radiofrequency ablation (RFA), and their combination in patients with recalcitrant PF. METHODS: In this retrospective study, a total of 156 patients with ultrasonographically confirmed plantar fasciitis, experiencing heel pain for at least 6 months and unresponsive to ≥ 3 months of standard conservative therapy, were included; 52 received RFA, 50 received CI, and 54 underwent combined therapy. Pain intensity (visual analog scale [VAS]), functional status (Foot Function Index [FFI], Roles and Maudsley score [RMS]), plantar fascia thickness (PFT), and relapse rates at 12 months were assessed. Within-group and between-group differences were assessed using appropriate nonparametric tests, and relapse rates were compared accordingly. RESULTS: All treatment modalities improved VAS, FFI, RMS, and PFT at 6 months (p < 0.001). VAS declined from 6.73 to 6.81 at baseline to 1.62 in the RFA group and 1.83 in the combined group, whereas remaining at 6.56 in the CI group. FFI dropped from ∼52 to 21.50 and 17.57 in the RFA and combined groups but remained at 46.62 in the CI. PFT decreased from ∼6.2 mm to 3.29, 2.71, and 2.95 mm, respectively. Relapse occurred in 12 (23.1%), 19 (38.0%), and 8 (14.8%) patients in the RFA, CI, and combined groups. Between-group differences were significant at 6 months (p < 0.001). No major adverse events were observed. CONCLUSION: Both CI and RFA are effective in recalcitrant PF, but their combination provides superior and more durable improvements in pain, function, and fascia morphology, with the lowest relapse rates. Ultrasound-guided combined therapy suggests a safe, practical, and effective treatment option for patients unresponsive to conservative measures.