Ultrasound-guided perineural tibial nerve dextrose injection for plantar fasciitis: a case series highlighting safety and efficacy

Treatments for plantar fasciitis are often unsatisfactory. Dextrose exerts an analgesic effect through inhibiting transient receptor potential vanilloid receptor 1 (TRPV1)-mediated neuroinflammation. We reported the effectiveness of ultrasound-guided perineural tibial nerve (TN) 5% dextrose water (D5W) injection using the hydrodissection technique in treating plantar fasciitis. Two patients, a 52-year-old woman and a 60-year-old overweight man, presented with chronic left heel pain. Both had tried various treatments without sustained improvement. Ultrasound demonstrated an increase in the thickness of the plantar fascia, confirming the diagnosis of plantar fasciitis. Due to painful experience during previous intervention, they sought a less painful and more durable treatment option. We performed perineural TN ultrasound-guided D5W injection using the hydrodissection technique in two sessions, resulting in significant pain reduction and a less painful injection experience. A one-month follow-up showed sustained pain relief. Perineural TND5W injection using the hydrodissection technique appears to be an effective treatment option for plantar fasciitis.