Ultrasound-Guided Tibial Nerve Block vs. Local Corticosteroid Injection in Recalcitrant Plantar Fasciitis Treatment: A single blind randomized controlled study.

Abstract

Recalcitrant plantar fasciitis persisting after conservative care and extracorporeal shock wave therapy (ESWT) remains a therapeutic challenge. Our aim was to evaluate the clinical efficacy and procedural tolerability of tibial nerve block (TNB) compared to local corticosteroid injection (CSI). This is a prospective, single-blind randomized controlled trial. In this study 69 adults with ESWT-refractory plantar fasciitis were randomized (1:1:1) to conservative care (control), ultrasound-guided CSI (intrafascially) or ultrasound-guided TNB (perineurally). Pain (VAS), plantar fascia thickness (PFT), Heel Tenderness Index (HTI) were assessed at baseline, 1 week, 1 month, and 3 months; and SF-12 and IPAQ-SF at baseline and 3 months. Injection-related pain (VAS-injection) was recorded during procedures. No significant VAS change occurred in controls. Both CSI and TNB produced significant VAS and HTI improvements at all follow-ups versus baseline (p < 0.001), attenuating by 3 months. Between-group differences in pain reduction were not significant. PFT decreased only after CSI at 1 week (p = 0.002) and 1 month (p = 0.015), with loss of effect at 3 months. Injection pain was significantly lower with TNB than CSI (p < 0.001). SF-12 improved at 3 months; IPAQ-SF did not. Ultrasound-guided TNB provides clinically meaningful short-term analgesia comparable to CSI while avoiding intrafascial injection and reducing procedural pain; importantly, it may also serve as a valuable treatment option for patients in whom corticosteroid use is contraindicated.