Treat plantar fasciitis with a 2-step virtually painless procedure. Tibial nerve block enables almost painless anesthesia for most of the sole of the foot for a secondary procedure. Find the nerve adjacent to the artery in the medial ankle and inject under direct ultrasound guidance with sterile technique at preferred location. PRP or steroid can then be injected into the anesthetized plantar fascia under direct ultrasound guidance.
so this patient suffering from plantar fasciitis related to a heel spur i'm going to give her a prp injection platelet-rich plasma to reduce inflammation and promote healing prior to doing that i'm going to give her a tibial nerve block to reduce the pain so that i don't need to put any local anesthetic with my prp i don't want anything to interfere with the activity of the prp so i'm going to go proximal to the tibial nerve which innervates the medial and inferior aspect of the foot and will hopefully give her enough anesthesia for the procedure so to find the tibial nerve i'm locating the medial malleolus i visualize the nerve next to the artery and one option is to go towards the tarsal tunnel which is over here you have tom dick and harry tibialis posterior followed by flexor digitorum profundus and then flexor hallucis longus with the tibial nerve in between them another option is to go more proximal for the tibial nerve and follow it up in the ankle so to the right of the screen we see the achilles tendon so here we see the nerve next to the artery we're going to give her a little vapor coolant spray for skin anesthesia a little pinch so as you see here is my needle it's surrounding the nerve the black around the needle is the local anesthetic now we're going to image the plantar fascia i put my probe underneath the calcaneus the fat pad is the most superficial followed by the beginning of the plantar fascia as i scan distally you see the fascia okay so we need alcohol thank you so now i'm going to insert the prp aiming for the plantar fascia and you can see my needle entering into the fascia i'm depositing the prp superior to the fascia as well as into the fascia if there's resistance i'm not injecting sorry and you may be a little short here after but it's going really well nice and smooth this is what nice this is the way it should feel so basically this patient underwent a tibial nerve block prior to the prp injection the prp was injected into the plantar fascia which can be a painful shot the tibial nerve block alleviated the symptoms or the pain of the injection the prp is now on the plantar fascia it may take a few days two weeks to work but will hopefully give her pain relief superior to that of steroids you
