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Öğe Analysis of orthopedic surgery of patients with metastatic bone tumors and pathological fractures(Sage Publications Ltd, 2018) Sevimli, Resit; Korkmaz, Mehmet FatihObjective This study was performed to determine the most common causes, locations, and treatments of metastasizing primary tumors through evaluation of patients with metastatic bone tumors who were admitted to our clinic. Methods In total, 96 patients with metastatic bone tumors who were admitted to our clinic from 2000 to 2016 were included in the study. Results The breast (30 patients, 31.3%) and lung (18 patients, 18.8%) were the most commonly metastasized primary organs. The femur was the most commonly metastasized bone. Conclusions Bone tumors in patients of advanced age are, unless otherwise proven, considered to be metastatic, and the development of specific diagnostic and treatment algorithms is needed. Clinicians should attempt to improve the general condition of patients with tumors exhibiting bone metastasis to increase the patients' quality of life by providing early mobilization. Thus, appropriate patient selection and proper internal fixation are essential.Öğe BIOCHEMICAL EFFECT EVALUATION OF MICROBIAL CHONDROITIN SULPHATE IN EXPERIMENTAL KNEE OSTEOARTHRITIS MODEL(Parlar Scientific Publications (P S P), 2022) Erenler, Ayse Sebnem; Karabulut, Aysun Bay; Sevimli, Resit; Geckil, Hikmet; Akpolat, Nusret; Unver, Tuba; Otlu, OnderOsteoarthritis (OA) is the most common chronic joint disease, primarily due to aging. Chondroitin sulfate (CS) is a glycosaminoglycan (GAG) commonly used to treat osteoarthritis. CS can delay the progression of pathology or reverse morphological changes in joint structure. Traditionally CS is produced from animal sources. However, due to different reasons such as contamination, ecological risk, and the possibility of infectious diseases, the trend towards microbial sources has increased because of its advantages such as purer, more antiallergic, and lower Molecular Weight (MW) than animal sources. Biochemical analysis of Microbial CS (MCS), which is a new and significant alternative as a source of CS in the OA healing process, has not been evaluated in the literature yet. This study was designed to analyze the biochemical effects of MCS produced by our team from a microbial source, with an MW value of 269 Daltons, on the osteoarthritis healing process compared to the commercial foiut. We aim to reach data that MCS has a higher antioxidant effect than animal -sourced CS, and in this way, it is a more suitable production for the treatment of osteoarthritis. In this study, knee osteoarthritis was surgically induced in experimental rabbits; and TGF113, CAT, MPO, TOS, and OSI parameters measured in blood samples before the operation and after the healing period were analyzed comparatively. After the surgical application, the rabbits were randomly divided into three groups: control, animal -sourced CS, and E. cull sourced. MCS. The standard rabbit diet was administered daily to 10 rabbits in Group 1 (control), and. CS and MCS were applied daily to the other groups as 17 mg/kg for 12 weeks. Blood samples were taken from rabbits at the 12th week after surgery, and TGF-113, CAT, MPO, TOS, and OSI parameters were biochemically evaluated. This study has confirmed that the antioxidant properties of MCS and data on its effectiveness in controlling oxidative stress compared to animal -sourced CS. Based on these results, it can be concluded that MCS has a significant potency of nutraceutical and therapeutic agents for OA treatment.Öğe Cloning and Expression vgb-kfo Genes in E. coli and Microbial Chondroitin Sulfate Production(Amer Scientific Publishers, 2019) Erenler, Ayse Sebnem; Geckil, Hikmet; Karabulut, Aysun Bay; Akpolat, Nusret; Sevimli, Resit; Ulke, Esra; Aliyeva, AygunThis study focused on a new plasmid and new recombinant strain developed for the production of microbial chondroitin sulfate a new and limited area of study the strategies we applied for the production of microbial chondroitin sulfate, and the possible contributions of this study to published research literature. In this study, pETM6-PACF, which carries the genes responsible for capsular chondroitin synthesis [kfA, kfoC, kfoF] was used as the basic plasmid. The Vitreoscilla hemoglobin gene region was transformed into this basic plasmid and the common expression of both gene groups was added to research literature for the first time. This plasmid was transferred to non-pathogenic E. coil (C2987) to produce a completely new chondroitin source specific to this study. Following the transformation by chondroitin synthesis, and the subsequent microbial production of chondroitin by the application of purification protocols, microbial chondroitin sulfate was produced in sulfate form. Consequently, in comparison to published literature, a product with a low molecular weight value of 269 Daltons was developed. This product, which has significant potential drug potency, can be used in many different areas as a novel and unique biomedical product.Öğe Comparison of medium-term revision rates after autograft and allograft anterior cruciate ligament reconstruction(Edizioni Luigi Pozzi, 2020) Sevimli, Resit; Gormeli, Gokay; Polat, Haci; Kilinc, Oner; Turkmen, Ersen; Aslanturk, OkanAim: The present study investigates time until revision and revision rates, and their relationship with gender and age, among 267 patients with anterior cruciate ligament tears treated with autograft and allograft reconstructions. MATERIALS AND METHODS: A retrospective evaluation was carried out based on data collected on 269 knees (bone-patellar tendon-bone autograft in 25, gracilis-semitendinosus autograft in 136, quadriceps autograft in two, allograft in 106) belonging to 267 patients who underwent an anterior cruciate ligament reconstruction between 2009 and 2018. RESULTS: Of the 269 knees of the 267 patients (22 women and 247 men) operated on for an anterior cruciate ligament rupture, an autograft was used in 163, and nine of those required revision, while an allograft was used in 106 knees, and seven required revision. Revision surgery was necessary for six out of the 22 female patients and for only 10 out of the 247 male patients (p<0.001). CONCLUSION: Each type of graft used for treatment is associated with certain advantages and disadvantages. Hamstring autografts and allografts were the most commonly used grafts during the anterior cruciate ligament reconstruction surgeries carried out at our clinics. The rate of re-rupture was quite low with use of both graft types, leading us to believe that the type of graft preferred for anterior cruciate ligament reconstruction surgery should be based on a common decision of the surgeon and patient.Öğe The comparison of radiologic measurements of the hip parameters between girls and boys(Bayrakol Medical Publisher, 2022) Calisgan, Elisa; Akyol, Betul; Sevimli, Resit; Turan, Caner CengizAim: This study aimed to compare the radiologic measurement of hip parameters between girls and boys aged 3,5 to 4 years. Material and Methods: This retrospective study included 112 healthy children (n:57 girls, n: 55 boys) aged 3,5 to 4 years who required radiological images due to examination. Radiological images from Inonu University, Faculty of Medicine, Department of Orthopedia were used in the study. The measurements taken from the children were right and left femur head ossification, acetabular index and femur inclination angle. Results: In girls, median right femur head ossification was 16.80 mm, median left femur head ossification was 15.30 mm, median right acetabular index was 24.10(0), median left acetabular index was 23.80(0), median right femur inclination angle was 147.40(0), median left femur inclination angle was 147.50 degrees. In boys, median right femur head ossification was 18.40 mm, median left femur head ossification was 19.50 mm, the median right acetabular index was 17.40 degrees, the median left acetabular index was 17.50 degrees, median right femur inclination angle was 147.50 degrees, and median left femur inclination angle was 148.70 degrees. Discussion: A statistically significant difference was found between girls and boys regarding right and left femur head ossification and acetabular index. This contributes to the determination of gender differentiation, gold standard values of hip parameters for diagnosis, evaluation and prognosis of hip diseases in children aged 3,5 to 4 years.Öğe Determining the Optimal Length and Safety of Pedicle Screws in the T12 Vertebra: A Morphometric Study(Springernature, 2018) Korkmaz, Mehmet F.; Erdem, Mehmet N.; Ozevren, Huseyin; Sevimli, ResitIntroduction: Despite the developments in implant technology and imaging methods and the advances in surgical techniques, there are still potential problems and complications of transpedicular screw application. This is a morphometric study to examine the proximity of the T12 vertebra to the thoracic aorta. Our aim was to define the appropriate length of the pedicle screw to be used in the 12 th thoracic vertebra, using computed tomography (CT) data. Methods: Randomly selected cases from the same ethnic group in a specific age group were examined in terms of the length from the anterior vertebral body and the screw entry point of the T12 vertebra to the thoracic aorta. In light of these data, a statistical analysis was made for the selection of the most appropriate screw length. Results: A statistically significant difference was detected in the distance from the T12 left screw entry point to the aorta between males and females (p=0.001). No statistically significant correlation was found between age and the distance between the left screw entry point and the aorta (p=0.105). Also, no statistically significant difference was detected between the T12 vertebral body-aorta distance in males and in females (p=0.212). The relationship between the shortest aorta-vertebral body distance and age was not statistically significant (p=0.7). Similarly, there was no statistically significant difference between the left screw entry pointaorta distance and the aorta-vertebral body shortest distance (p=0.731). Conclusions: Significant differences were observed between males and females in terms of the distance between the T12 vertebra left screw entry point and the thoracic aorta (p=0.001). Thus, we can assert the need for the preoperative evaluation of patients with computed tomography in selecting the appropriate screw length and avoiding complications.Öğe Determining the optimal length and safety of pedicle screws in the t12 vertebra: a morphometricstudy(Cureus ınc, po box 61002, palo alto, ca 94306 usa, 2018) Korkmaz, Mehmet F.; Erdem, Mehmet N.; Ozevren, Huseyin; Sevimli, ResitIntroduction: Despite the developments in implant technology and imaging methods and the advances in surgical techniques, there are still potential problems and complications of transpedicular screw application. This is a morphometric study to examine the proximity of the T12 vertebra to the thoracic aorta. Our aim was to define the appropriate length of the pedicle screw to be used in the 12 th thoracic vertebra, using computed tomography (CT) data. Methods: Randomly selected cases from the same ethnic group in a specific age group were examined in terms of the length from the anterior vertebral body and the screw entry point of the T12 vertebra to the thoracic aorta. In light of these data, a statistical analysis was made for the selection of the most appropriate screw length. Results: A statistically significant difference was detected in the distance from the T12 left screw entry point to the aorta between males and females (p=0.001). No statistically significant correlation was found between age and the distance between the left screw entry point and the aorta (p=0.105). Also, no statistically significant difference was detected between the T12 vertebral body-aorta distance in males and in females (p=0.212). The relationship between the shortest aorta-vertebral body distance and age was not statistically significant (p=0.7). Similarly, there was no statistically significant difference between the left screw entry pointaorta distance and the aorta-vertebral body shortest distance (p=0.731). Conclusions: Significant differences were observed between males and females in terms of the distance between the T12 vertebra left screw entry point and the thoracic aorta (p=0.001). Thus, we can assert the need for the preoperative evaluation of patients with computed tomography in selecting the appropriate screw length and avoiding complications.Öğe The effect of the use of herbal supply on daily life activities containing OTC (chondroitin sulfate(Bayrakol Medical Publisher, 2020) Sevimli, Resit; Guler, Ahmet; Canakci, Mehmet; Emeli, Adem; Turkmen, ErsenAim: In this study, we aimed to compare pain, functional capacity, and quality of life of patients with knee osteoarthritis (OA), determine the factors affecting them, and investigate the effect of over-the-counter (OTC)-containing herbal supplementation on daily living activities in patients with knee OA. Materials and Methods: The study included 102 patients with the diagnosis of knee OA according to the American College of Rheumatology (ACR) criteria who were admitted to our orthopedics and traumatology outpatient clinic between March 2019 and September 2019. Demographic data were recorded. The visual analog scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), medical outcomes study short-form health survey (SF-36) were used. The Kellgren-Lawrence scale was used for radiological evaluation. Information about the patients was determined by the questionnaire method and the patients were evaluated according to recruitment/exclusion criteria. In the study group, 102 patients with knee OA were included. On the other hand, 100 patients received a placebo as a control group. After three months of OTC supplementation, daily life activities and functional tests were performed and data were collected. Both subjective and objective data were calculated, compared, and analyzed. Results: It was observed that more than 80% of the patients with OA included in the study relieved pain with our food supplement components. There was an improvment in functional abilities of the patients with chronic OA as compared to standard medical treatment, and the pain level decreased significantly with test scores and scales after supplementary foods. The secondary endpoint was also noticed. We noticed that our subjects actually lost an average of 1.5 kg over the course of the study. Discussion: OA is the most common form of arthritis and the leading cause of disability among middle-aged and elderly people. We can develop theoretical strategies for primary prevention of joint damage through the reduction of obesity and joint trauma in particular. Effective chondroprotective therapies will be most useful when applied to high-risk individuals before the emergence of symptomatic OA. Conclusion: We concluded that food supplementation that was used in our study seemed to be beneficial in patients with knee ailments such as OA. It was equally interesting to observe that the majority of patients lost weight while taking these supplements. Although the study was underpowered, it shed light on supplements containing glucosamine. We believe that further larger series studies in the near future can help us to obtain more objective findings.Öğe Langerhans Cell Histiocytosis with Atypical Intervertebral Disc and Sacroiliac Joint Involvement Mimicking Osteoarticular Tuberculosis in an Adult(Aves, buyukdere cad 105-9, mecıdıyekoy, sıslı, ıstanbul 34394, turkey, 2016) Ozdemir, Zeynep Maras; Kahraman, Aysegul Sagir; Gormeli, Cemile Ayse; Sevimli, Resit; Akpolat, NusretBackground: Langerhans cell histiocytosis (LCH), typically found in children, is a rare single or multisystem disorder with a wide range of clinical and radiological manifestations. Unusual presentations of LCH are occasionally encountered and it may be difficult to distinguish LCH from an infection or a benign or malignant tumor. Results: A 35-year-old female presented with pain in her back and left buttock, malaise, and weight loss, with a duration of several months. Her laboratory test results were within the normal ranges except for the levels of acute phase reactants, which were elevated. Magnetic resonance imaging and computed tomography revealed a unilateral destructive sacroiliac lesion, and multiple vertebral lesions with adjacent discal involvement and extensive soft tissue extensions. She was initially misdiagnosed with multifocal osteoarticular tuberculosis. An open biopsy and joint curettage was performed. Histopathological examination showed that she had LCH. Conclusion: To the best of our knowledge, this is the first case of LCH associated with a destructive unilateral sacroiliac lesion, discal involvement, and involvement of the adjacent vertebrae, in an adult patient; the LCH mimicked osteoarticular tuberculosis. Disease onset in adulthood is rare, and this can potentially delay diagnosis. Familiarity with the imaging features of unusual LCH manifestations is necessary to ensure accurate diagnosis and appropriate treatment.Öğe Mid-term outcome of wide resection in musculoskeletal fibrosarcoma patients(2020) Sevimli, Resit; Emeli, Adem; Eriten, SemihThe aim in this study, musculoskeletal system fibrosarcomas which are rare malignant soft tissue tumors that originate from fibroblasts, was to evaluate the mid-term outcome of patients that were diagnosed, treated and followed-up at our clinics. Included in the study were 12 patients treated for fibrosaecoma at our clinics between 2014 and 2017. The patients were evaluated in terms of age, location of tumor and time of resection, and were followed-up for mid-term recurrence. A wide resection was performed on all patients. No recurrence was found in all but one patient during follow-up. Musculoskeletal system fibrosarcomas are rare but represent high mortality and morbidity risks since the diagnosis is commonly delayed. The most frequently seen symptom is a painless mass reaching large dimensions. Early diagnosis plays a major role in prognosis, as is the case with other malignant tumors. In conclusion, we suggest that malignancy should be considered in the presence of giant, fixed and painful tumors, and a wide resection should be applied.Öğe Mid-Term Outcomes of Arthroscopic Treatment in Patients with a Stiff Elbow(Springernature, 2018) Sevimli, Resit; Aslanturk, Okan; Ergen, Emre; Ertem, KadirIntroduction Loss of function and pain are the main complaints at the time of hospital admission for patients with a stiff elbow. In this study, we present mid-term radiological and functional results for the use of the arthroscopic release technique in patients admitted to the outpatient clinic with a stiff elbow. Methods A total of 22 patients (six females, 16 males; mean age: 36 years, range: 18 to 56 years) who underwent an arthroscopic intervention for traumatic or non-traumatic stiff elbow and arthrosis between January 2005 and November 2015 were included in the study. All patients started elbow movement after the first day following surgery. Pre- and postoperative radiological evaluations of patients were carried out, in addition to functional evaluation to measure the range of motion of the elbow joint and the Disabilities of the Arm, Shoulder and Hand (DASH) scores before and after surgery. Results The mean follow-up was 28.4 (range: 21 to 118) months. The mean preoperative flexion-extension arc of the patients was 89 degrees (range: 0 degrees to 115 degrees), and the mean flexion-extension arc increased to 103.5 degrees (range: 52 degrees to 128 degrees) at the final follow-up visit (p < 0.05). The mean preoperative DASH score was 42.17 (range: 33 to 81), decreasing to 30.35 (range: 9.7 to 41.3) postoperatively (p<0.05). In the final visit, none of the patients were found to require additional surgical interventions for the elbow. Conclusions Arthroscopic release can be considered a safe and effective option to obtain range of motion in joints in post-traumatic stiff elbow cases.Öğe Mid-term results of treatment with curettage and grafting in tumor-like cysts of long bones(Inonu University Faculty of Medicine ,DepaInonu University Faculty of Medicine ,Department of Orthopaedics and Traumatology, Malatya, Turkey, 2018) Encan, Mehmet Esref; Sevimli, ResitÖz: Aim: Curettage and bone grafting are common methods in the treatment of tumor-like cysts in the bone. In this study, we present our treatment results of curettage and bone grafting in patients with tumor-like bone cysts. Material and Methods: Ninety-three patients (57 males, 36 females, mean age: 33 years; range: 3 to 67 years) who were diagnosed with the tumor-like bone cysts in our clinic between march 2009 and December 2016, were evaluated. Curettage and bone grafting treatment were applied to all patients. The efficacy of the treatments was evaluated according to the Neer/Cole classification, and recurrence rates were recorded. Results: Of the treated 93 patients, 35 had a non-ossifying fibroma (NOF), 22 had an aneurysmal bone cyst(ABC), 21 had a unicameral bone cyst(UBC), and 15 had fibrous dysplasia(FD). Thirty-nine of these cysts were located in the femur,23 in the tibia, 22 in the humerus, six in the fibula, and three in the radius. Recurrence rates were observed as 14.3% (n=3) in UBCs, 13.6% (n=3) in ABCs, and 2.9% (n=1) in NOFs.In the tumor-like bone cysts, post-treatment complications were as follows: infection in five patients (5.3%), wound site problems in 11 patients (11.8%), deformity, fracture, coxa vara, limitation of the range of motion, and lower extremity shortness in nine patients (9.6%). Conclusion: These study results show that curettage and bone grafting for the patients who are admitted to the hospital with tumorlike lesions are effective and useful treatment modalities in the orthopedic oncology.Öğe A patellar giant-cell tumor with soft tissue involvement: an alternative treatment method and review of the literature(Turkish Joint Diseases Foundation, 2015) Gormeli, Gokay; Gormeli, Cemile Ayse; Ozdemir, Zeynep Maras; Sevimli, Resit; Akpolat, NusretIn this article, we report a case of a giant-cell tumor of the patella which occurred in an atypical location with soft tissue involvement, which makes our case clinically and radiologically unique. A 24-year-old patient was admitted to our clinic with a complaint of anterior knee pain. Radiological examination and percutaneous fine needle biopsy showed a diagnosis of giant-cell tumor of the patella. The patient underwent patellectomy with en-bloc resection of the lesion with totally involved soft tissue components and the extensor mechanism was reconstructed with two Achilles allografts. After surgery, the diagnosis was confirmed by histopathological examination. At 12 months, the patient had no recurrence with 110 degrees flexion and 30 degrees extension of the range of motion of the knee. Lysholm knee score was 72. At 90 degrees/sec isokinetic muscle strength test, the muscle strength loss was found to be 51.1% in the extensor and 21.1% in the flexor, compared to non-involved knee. In conclusion, giant cell tumors are difficult to treat, as they are destructive lesions with high recurrence rates. Despite reduced range of motion and muscle strength, based on our study results, we believe that our surgical treatment modality may be an alternative for the treatment of patellar giant cell tumors.Öğe Preparation, characterization, and biocompatibility of chondroitin sulfate-based sol-gel coatings and investigation of their effects on osseointegration improvement(Taylor & Francis As, 2023) Pasahan, Aziz; Sevimli, Resit; Kivilcim, Nilufer; Acari, Idil Karaca; Erenler, A. Sebnem; Sezer, Selda; Durmat, H. TurgutIn this work, implants with enhanced antibacterial and surface properties besides mechanical, biological, and chemical properties were prepared with the replacement of traditional titanium and titanium alloys in the field of biomedical materials. Titanium substrates were coated with chondroitin sulfate (CS) containing (3-glycidoxypropyl)trimethoxysilane (GLYMO) and tetraethoxysilane (TEOS) based thin film using sol-gel technology. Chondroitin sulfate is a preferred material due to its characteristics antioxidative and osseointegresion properties besides its collagen-forming properties. Coated implants were morphologically elucidated with atomic force microscopy (AFM), and scanning electron microscopy (SEM). The structure of the chondroitin sulfate-containing films was investigated with Fourier Transform Infrared Spectroscopy (FTIR) and Energy Dispersive X-Ray Analysis (EDX) techniques. The obtained CS-based sol-gel surface coatings are thermally stable up to similar to 200 degrees C according to TGA and DTA analysis results. The biological and antibacterial properties of the coatings were also determined. The biocompatibility and osseointegration properties of the coatings developed within the scope of the study were, determined by in vivo studies on rats. According to biocompatibility results of CS/Sol-Gel coated surfaces, Cell viability (%) rates of CS-based coatings showed between 89 and 66%. According to the experimental data, it has been claimed that implants improved with antibacterial, stable, homogeneous, and biocompatible coatings can be used as a new alternative product for dental and orthopedic applications.Öğe The prevalence of vitamin d deficiency-insufficiency in medical faculty students(Inonu University Medical Faculty Department of Pediatrics, Malatya, Turkey, 2018) Sevimli, Resit; Yakinci, Cengiz; Encan, Mehmet Esref; Polat, Haci; Sakci, Mehmetsah; Sagir, Ahmet; Kayhan, EdaÖz: Aim: The vitamin D deficiency is a pandemic health problem due to worldwide modernization. We tried to determine the impact of the reduced sun exposure on the vitamin D levels of the medical faculty students due to the long study hours and indoor study environment and classrooms. Material and Method: Two-hundred and eleven (113 women, 98 men) medical faculty students were included in the study. Blood samples were obtained from the students and serum 25 hydroxyvitamin D3 levels were measured on the same day. Students were healthy individuals, aged 17-29 years (mean age= 19 years). Data were analyzed using SPSS software program. The frequency distribution of the qualitative data and arithmetic mean, minimum, maximum and standard deviation of the quantitative data were used to define descriptive statistics. Non-parametric tests and Chi-square test were used for the analysis of qualitative data; the analysis of the quantitative data was done by observing normally distributed data. The significance level of Chi-square test, independent-student t-test and Mann-Whitney U test were accepted as p?0.05. Results: Serum 25 hydroxyvitamin D3 levels was below 20 ng/ml in 56% (n=118) of the students, of which 72% (n=85) were women. Conclusion: Especially, women had high levels of vitamin D deficiency in our study. This high ratio gives rise to thought that women spend more of their time indoor spaces due to modernization., women are exposed to sun light less than men, and thus they have higher levels of vitamin D deficiency.Öğe Total Hip Artroplasty(Derman Medical Publ, 2015) Korkmaz, Mehmet Fatih; Sevimli, Resit[Abstract Not Available]Öğe Treatment of Chronic Plantar Heel Pain With Radiofrequency Neural Ablation of the First Branch of the Lateral Plantar Nerve and Medial Calcaneal Nerve Branches(Elsevier Science Inc, 2016) Arslan, Aydin; Koca, Tuba Tulay; Utkan, Ali; Sevimli, Resit; Akel, IbrahimFrom March 2012 to February 2013, 37 patients experiencing plantar heel pain for >= 6 months despite treatment with physical therapy and other conservative treatment modalities were followed up. If neurogenic heel pain originating from the first branch of the lateral plantar nerve was present, with or without the medial calcaneal nerve, diagnostic nerve blocks to these nerves were performed for confirmation. If the pain was determined to be of neurogenic origin, radiofrequency neural ablation (RFNA) was applied to the corresponding sensory nerve endings. Pain was evaluated using the visual analog scale, and patients were followed for at least one year. A total of 41 feet from 37 patients (30 [81.1%] females, 7 [18.9%] males; mean age, 50.7 +/- 1.6 years; mean bodymass index, 30.6 +/- 0.7 kg/m(2)) were included. The mean visual analog scale scores improved significantly from 1 to 6 to 12 months after the procedure relative to before the procedure, with 88% of all patients rating the treatment as either very successful or successful at 12 months postoperatively. RFNA applied to both the first branch of the lateral plantar nerve and the medial calcaneal nerve sensory branches (16 [39%] feet) and only the first branch of the lateral plantar nerve sensory branches (25 [61%] feet) showed similarly high levels of success. Of the 41 feet, 28 [68.3%] had received extracorporeal shockwave therapy, 35 [85.4%] had received steroid injections, and 22 [53.7%] had received both extracorporeal shockwave therapy and steroid injections before RFNA as an index procedure. All were unresponsive to these previous treatments. In contrast, almost all (88%) were treated successfully with RFNA. Despite a high incidence of neurologic variations, with a precise diagnosis and good application of the technique using the painful points, chronic plantar heel pain can be treated successfully with RFNA. (C) 2016 by the American College of Foot and Ankle Surgeons. All rights reserved.
