Tibial Nerve Block as Treatment of Chronic Foot Pain

Michael W J Ritt; Henk Koning; Bella V van Dalen; Bas C Ter Meulen

doi:10.5812/aapm-131180

Tibial Nerve Block as Treatment of Chronic Foot Pain

Anesth Pain Med. 2023 Jan 13;13(1):e131180. doi: 10.5812/aapm-131180. eCollection 2023 Feb.

Authors

Michael W J Ritt¹, Henk Koning², Bella V van Dalen³, Bas C Ter Meulen⁴

Affiliations

¹ Department Intensive Care, Red Cross Hospital, Beverwijk, the Netherlands.
² Department of Pain Therapy, Pain Clinic De Bilt, De Bilt, the Netherlands.
³ Department of Orthopedics, Bergman Clinic, Naarden, the Netherlands.
⁴ Department of Neurology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.

Abstract

Background: Minimally invasive therapies can alleviate pain and improve walking in individuals with persistent foot and ankle pain.

Objectives: The current study aimed to define the protracted consequences of tibial nerve blocks with steroids for individuals with persistent foot pain and to investigate the link between the thermography of the plantar foot and the beneficial effect of a tibial nerve block with steroids.

Methods: All patients with chronic foot pain (n = 45) in this cohort underwent a block of the tibial nerve in the Department of Pain Therapy of Pain Clinic De Bilt, Utrecht, Netherlands, within November 2019 to April 2020. The thermographic images of patients were taken before and after injection. Results were retrospectively evaluated after 18 months.

Results: In this study, 53% of the patients had pain relief at 7 weeks of follow-up with a unilateral or bilateral block of the tibial nerve. An improvement in walking distance was reported by 22% of the patients. Side effects of the tibial nerve block reported at 7 weeks of follow-up increased pain (5%) and the occurrence of leg cramps (5%) among the treated patients. At 18 months, 45% of the successfully treated feet still had benefits. A difference between the big toe's temperature and the foot's average temperature of less than -0.9°C on thermography before and after the tibial nerve block can predict a beneficial result of therapy.

Conclusions: Tibial nerve block provides a safe, minimally invasive treatment option for almost half of the patients with painful feet in this cohort, and when successful, it can last a long term. Thermographic imaging of the plantar foot can predict only to a small extent the beneficial effect of the tibial nerve block with steroids on foot pain. Tibial nerve block should be considered when custom foot orthoses have been inadequate for pain relief or restricted walking distance.

Keywords: Chronic Regional Pain Syndrome; Interventional Pain Management; Neuropathic-Like Pain; Tibial-Peroneal Nerve Block.