Plantar Fasciitis Embolization vs. Radiofrequency Ablation

Quick Answer

Radiofrequency nerve ablation quiets the small nerves that carry heel pain, radiofrequency microtenotomy (Topaz) treats the fascia tissue, and embolization (PFE) reduces abnormal blood flow around the fascia. No study has compared PFE with either radiofrequency procedure, so none can be called the better choice.

"Radiofrequency" shows up in two quite different heel pain procedures, and both are sometimes offered to the same people who ask about plantar fasciitis embolization (PFE): those whose pain has outlasted stretching, inserts and injections. This guide explains how each one works, what has been published and where the gaps are. Dr. Fox performs PFE and does not perform radiofrequency procedures, so we have tried to describe them the way their own research does.

Three procedures, three different targets

Radiofrequency nerve ablation (RFNA) targets the small sensory nerves that carry pain signals from the heel. A thin probe is placed through the skin next to the nerve branch, and radiofrequency energy heats the tip to interrupt the nerve's signal. Studies have treated branches of the medial calcaneal nerve, the inferior calcaneal nerve (also called the first branch of the lateral plantar nerve), or both. A gentler variation called pulsed radiofrequency aims to quiet the nerve without destroying it.

Radiofrequency microtenotomy targets the plantar fascia itself. It is widely known by the brand name Topaz, after the wand used in most studies. The surgeon applies brief pulses of radiofrequency energy at a series of small points in the damaged fascia, either through tiny skin punctures or through a small incision. It is a fascia procedure, not a nerve procedure.

PFE targets the abnormal small blood vessels that can form around a chronically irritated plantar fascia. A vascular specialist reaches a small artery under imaging guidance and delivers tiny particles that reduce flow through those vessels. Nothing in the heel is cut or heated. Our plantar fasciitis embolization page describes the steps.

What the research shows for radiofrequency nerve ablation

RFNA has something neither of the other two has: a randomized, sham-controlled study, though a very small one.

Landsman and colleagues, 2013 (randomized, double-blinded, sham-controlled with crossover, 17 patients). Eight patients had the real treatment first and nine had a sham. The treated group improved significantly and the sham group did not. Sham patients who crossed over to real treatment after 4 weeks then improved as well.
Liden and colleagues, 2009 (retrospective, 22 patients, 31 feet). Average pain fell from 8.12 out of 10 to 1.46 at 1 month and was 2.07 at 6 months. The only adverse events were bruising and blood collecting at the probe entry site.
Erken and colleagues, 2014 (case series, 29 patients, 35 feet, 2-year follow-up). Average pain fell from 9.2 to 1.3 out of 10 at 2 years, and 85.7% of patients rated the treatment successful or very successful.
Arslan and colleagues, 2016 (37 patients, 41 feet). Patients first had numbing injections to confirm that a nerve was the source of pain. At 12 months, 88% rated the treatment successful or very successful.
Kurtoglu and colleagues, 2022 (retrospective, 261 patients, 378 feet). Pain and function scores improved significantly by 1 month and held at final follow-up, which ranged from 8 to 24 months.
Cozzarelli and colleagues, 2010 (retrospective, 82 patients). In telephone interviews at 5, 10 and 12 years, 89% reported no recurrence of pain. In that practice the procedure was done under general anesthesia and took about 15 to 20 minutes per heel.

For pulsed radiofrequency, a 2017 randomized, placebo-controlled trial of 36 patients found greater improvement in pain and function than a numbing injection at every check through 12 weeks.

The fair summary: one tiny randomized study, one small randomized trial of the pulsed version with short follow-up, and several uncontrolled series with good reported results. Most follow-up relied on patient questionnaires.

What the research shows for radiofrequency microtenotomy

Weil and colleagues, 2008 (prospective, 10 patients). All improved at 6 months and 1 year. One had pain return at 1 year. No complications were reported.
Sean and colleagues, 2010 (14 patients). Average foot function scores rose from 34.47 to 71.33 at 6 months, and 12 of 14 reported good to excellent satisfaction.
Tay and colleagues, 2012 (prospective, non-randomized, 48 patients, 59 feet). Pain improved at 1 year with both the open and the skin-puncture method, with somewhat more pain improvement in the open group.
Lucas and colleagues, 2015 (mailed questionnaire). Of 111 patients, 61 replied at an average of 33.3 months. Of those, 51 (83.6%) were satisfied.
Wang and colleagues, 2018 (comparative study). Endoscopic plantar fascia release gave earlier improvement at 3 months, but results were equivalent to open microtenotomy at 1 year.

A 2022 systematic review of 11 articles rated the evidence as fair and called for high-quality randomized trials. A 2025 meta-analysis of 15 studies with 1,576 patients reported an average pain reduction of 5.90 points on a 10-point scale and a complication rate of 3.00%. Its included studies were clinical trials, cohort studies and case series, so the pooled numbers carry the limits of those designs.

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This article is part of our Heel Pain Guide.

What the research shows for PFE

PFE is the newest of the three, and its evidence is the earliest.

Gill and colleagues, 2026 (prospective case series, 24 people). 17 of 24 (70.8%) met the study's responder definition at 6 months. No adverse events occurred.
Kumar and colleagues, 2026 (retrospective, 12 patients). Of 11 who could be treated, 8 (72.7%) had at least a 50% drop in pain at 6 months, sustained through 12 months.
Tonkaz and Bekci, 2026 (prospective, 32 patients). Average pain fell from 7.3 to 1.3 out of 10 at 6 months. Five patients with physically demanding jobs had a mild return of symptoms.
Sasaki and colleagues, 2025 (retrospective, 66 patients). Results held at an average follow-up of 30.9 months, with no major adverse events.

None of these studies had a comparison group, and there is no randomized or sham-controlled trial of PFE for plantar fasciitis.

There is no head-to-head trial

We searched PubMed for a study comparing embolization with either radiofrequency procedure for plantar fasciitis and found none. The studies above used different patients, different pain scales and different definitions of success, so their percentages cannot be lined up to pick a winner.

	RF nerve ablation	RF microtenotomy (Topaz)	PFE
What it targets	Small pain-carrying nerve branches	Damaged plantar fascia tissue	Abnormal small blood vessels
How it reaches the target	Probe through the skin of the heel	Wand through skin punctures or a small incision	Through an artery
Largest study found	261 patients, retrospective	Meta-analysis of 15 studies	66 patients, retrospective
Sham-controlled trial	One, 17 patients	None found	None
Longest follow-up found	Telephone interviews at up to 12 years	Average 33.3 months	Average 30.9 months

Who each may suit

These are general patterns to raise with your doctors, not rules.

RF nerve ablation may be worth asking about if your pain has a nerve quality, such as burning, or if a numbing injection near the heel nerves takes the pain away for a while. One study used exactly that kind of test injection to select patients. It is also an option some foot specialists offer when they want to avoid cutting the fascia.

RF microtenotomy may be worth asking about if imaging shows a thickened, degenerated fascia and you are already working with a foot and ankle surgeon who performs it.

PFE may be worth asking about if your plantar fasciitis is confirmed, has lasted many months despite conservative care, and you prefer an approach that does not cut, heat or remove tissue in the heel. It may not be suitable if you have poor circulation in the legs, kidney disease or a past reaction to contrast dye. See who is a candidate for PFE.

None of them is right if the diagnosis is uncertain. A stress fracture or fat pad problem will not respond to any of the three. Our guide to conditions mistaken for plantar fasciitis explains how these are sorted out.

Risks to weigh

The studies above reported few problems, but small studies cannot rule out uncommon ones. For nerve ablation, one series reported bruising at the probe site, and because the treated nerves carry sensation, it is reasonable to ask about numbness afterward. For microtenotomy, case reports describe skin cysts forming on the heel that needed surgical removal. For PFE, published series report no major adverse events, but it is an artery procedure, and a 2026 case report describes a blocked lower-leg artery after PFE done through an artery in the foot.

Questions to ask before you choose

Is my pain coming from the fascia, a nerve or both, and how do you know?
What kind of anesthesia do you use?
What will my first two weeks look like, and when can I return to my usual activity?
If this does not help, what would you suggest next, and does this procedure limit my other options?

Dr. Fox is a board-certified vascular surgeon. If your history suggests a nerve-focused or fascia-focused procedure makes more sense, he will say so and refer you back to a foot and ankle specialist.

For other comparisons, see PFE versus Tenex, alternatives to plantar fasciitis surgery and plantar fasciitis surgery recovery and success rates. The heel pain guide lists every article in this series, and the embolization guide covers other joints.

Frequently Asked Questions

Is embolization more effective than radiofrequency ablation for plantar fasciitis?

No one knows. No study has compared them head to head. Radiofrequency nerve ablation has one very small sham-controlled study, and PFE so far has only small series without a comparison group.

Is Topaz the same as radiofrequency nerve ablation?

No. Topaz is a radiofrequency microtenotomy that treats the plantar fascia tissue. Radiofrequency nerve ablation treats the small nerve branches that carry pain from the heel.

Does Dr. Fox perform radiofrequency ablation?

No. Dr. Fox is a vascular surgeon and performs embolization. Radiofrequency procedures for heel pain are offered by foot and ankle specialists and some pain specialists.

Can I have PFE if radiofrequency ablation did not help?

Possibly, but this has not been studied. It depends on your diagnosis, imaging and health history, so it needs an individual evaluation.

Keep Reading

Sources

Medically reviewed by David Fox, MD, FACS, RPVI. This article is general information, not a substitute for a medical evaluation.

Living with joint or tendon pain that hasn’t improved? Schedule a consultation with Dr. David Fox at Fox Vein & Vascular in Manhattan to find out whether embolization is right for you. Call (212) 362-3470 or request an appointment online.

Plantar Fasciitis Embolization vs. Radiofrequency Ablation and Topaz: How They Compare