Deep peroneal nerve block may be a new treatment way for plantar fasciitis

Abstract

Background Toe dorsiflexion is considered to be an important cause of plantar fasciitis, and the deep peroneal nerve (DPN) is the only nerve innervating the ankle joint and toe dorsiflexion. We hypothesized that blocking the DPN at the lower part of the tibia can reduce dorsiflexion of the toes at rest and in motion, thereby reducing plantar fascia tension, and will not affect the patient's normal activities. Methods Under ultrasound guidance, a DPN block was performed 2 cm above the ankle joint. Blocking twice a week for two consecutive weeks. The VAS pain scores at rest and movement were evaluated before and after treatment. The toe dorsiflexion angle change was observed in a static state, and the plantar fascia thickness changes before and after the block were observed by ultrasound to reflect the plantar fascia tension. Results We analyzed the location of DNP block on the specimen, and implemented DNP block in 18 patients with unilateral plantar fasciitis. DPN block reduces the heel pain in patients with plantar fasciitis both at rest and movement, the visual analog score (VAS) at rest at baseline with a MD (95% CI) of 3.77 (2.96 to 4.59) and at 2 weeks of treatment of 1.16 (0.62 to 1.71), the VAS at movement of baseline with a MD (95% CI) of (5.22 4.75 to 5.69) and at 2 weeks of treatment of 3.16 (2.43 to 3.89). After the block the angle of toe dorsiflexion at baseline with a MD (95% CI) of 20.50° (18.7 to 22.26) was decreased to 13.08° (10.88 to 15.27), and the thickness of plantar fascia at baseline with a MD (95% CI) of 4.56 mm (4.18 to 4.95) was increased to 5.53 mm (4.95 to 5.04), showing signs of decreased fascial tension. Conclusion From the perspective of balancing the biological force of the plantar fascia, using DPN block can improve the biomechanical position and tension of the plantar fascia to a certain extent to promote the recovery of the damaged fascia block. As far as we know, this treatment concept may be a new treatment way for plantar fasciitis.