Successfull Treatment of Plantar Fasciitis with Perineural Dextrose Injection

Abstract

A 62-year-old active career woman came to the clinic with a chief complaint of left heel pain for 7 months without numbness. She had previously sought consultation at several clinics and was prescribed oral nonsteroidal anti-inflammatory and opioid analgesic drugs with no improvement in symptoms. She was offered plantar corticosteroid injection therapy but refused due to fear of corticosteroid’s possible side effects. She had a medical history of dyslipidemia and no other comorbid diseases. She was obese with a body mass index of 27.3 kg/m2. There was tenderness at the plantar medial calcaneal tuberosity, rated as 7/10 on the pain scale. Tinel tests were negative on both feet. Musculoskeletal ultrasound examination demonstrated a 7.7 mm thickness of left plantar fascia. In comparison, her right plantar fascia thickness was 2.8 mm. Three milliliters of dextrose 5% were injected perineural to the tibial nerve, posteriorly to the left medial malleolus. The patient reported a significant reduction of pain to 3. The second session of perineural dextrose injection was performed after one week, resulting in a pain severity reduction to 1. The patient was also advised to consult a dietician for weight loss management and avoid barefoot walking. No study yet compares the efficacy between conventional corticosteroid injection and perineural dextrose injection in treating plantar fasciitis.

Keywords

• internal medicine
• rheumatology
• pain
• interventional pain