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.