Efficacy of tibial nerve block, local steroid injection or both in the treatment of plantar heel pain syndrome.

BACKGROUND

Plantar Heel Pain Syndrome (PHPS) describes centralised plantar heel pain and tenderness. It can account for up to 15% of referrals to clinicians involved in the treatment of foot pain.

OBJECTIVE

To compare tibial nerve block, local infiltration with steroid or both combined in the treatment of PHPS.

METHODS

Patients with PHPS were randomly assigned to three treatment groups: Group 1-steroid injection to heel; Group 2-local anaesthetic block to tibial nerve; Group 3-both procedures. Pain visual analogue scale (VAS) was measured at baseline and after 1, 6 and 26 weeks. Heel tenderness index (HTI) was measured at baseline and after 6 weeks. The patient rated their discomfort from the injection(s) using a VAS.

RESULTS

Forty-five patients (27 female) were recruited, 14 in Group 1, 12 in Group 2 and 19 in Group 3. Median age was 55, disease duration was 10 months and baseline pain VAS was 7.0 cm. All groups experienced a sustained improvement in pain VAS between baseline and weeks 1, 6 and 26 (all p<0.0001). Group 1 reported significantly lower pain VAS that those in Group 2 (p<0.01) or Group 3 (p<0.05) at week 6. Group 2 found the procedure less uncomfortable than Group 1 (p<0.01). The HTI was significantly higher in Group 2 at 6 weeks compared to Group 1 (p<0.005) and Group 3 (p<0.05).

CONCLUSIONS

This study suggests that the natural history of PHPS following an injection is encouraging, that a tibial nerve block reduces the discomfort of the procedure, that a steroid injection to the heel may accelerate improvement and that clinicians should consider a combination of both strategies.