Extracorporeal Shock Wave Treatment and Multimodal Pain Management for Tarsal Tunnel Syndrome Associated with Plantar Fasciitis

Case Report | Vol 4 | Issue 1 |  January-June 2024 | page: 31-34 | Ricardo Kobayashi

DOI: https://doi.org/10.13107/jrs.2024.v04.i01.133

Author: Ricardo Kobayashi [1]

[1] Department of Neurology, Pain Center, University of São Paulo, Brazil.

Address of Correspondence
Dr. Ricardo Kobayashi,
Department of Neurology, Pain Center, University of São Paulo, Brazil.
E-mail: koba@globo.com

Abstract

Introduction: Plantar fasciitis (PF) is an important cause of musculoskeletal pain and radial pressure waves (RPWs) can be used for patients not improving after 3 months of other non-operative measures. However, in refractory cases of PT, it is imperative to investigate possible differential diagnoses and one of its important differential diagnoses is tarsal tunnel syndrome (TTS). TTS is a rare but important condition which is regularly under diagnosed leading to a range of symptoms affecting the plantar aspect of the foot typically associated with a neuropathic pain pattern.
Case Report: We report a case of PF with TTS and associated neuropathic components. At first, nortriptyline 50 mg and 5% lidocaine patch were used, which improved the neuropathic pattern. After that, three RPW sessions were conducted at weekly intervals, with energy between 2 and 3 bars, frequency between 5 and 7 hertz. In addition to the area of greatest pain in the plantar fascia, treatment was also applied to the myofascial trigger points of the triceps surae and posterior tibial muscles. Three months after the last RPW session, the patient reported a 90% improvement in pain intensity, without limitations in daily activities.
Conclusion: This case highlights the importance of differential diagnoses of PF, especially before the indication of RPW in refractory cases. In addition to the neuropathic pattern associated with TTS, neuropathic pain associated with tendinopathies of the lower limbs is common (1/4 of cases) and needs to be identified and treated in conjunction with tendinopathy for a more effective result.
Keywords: Chronic pain, Plantar fasciitis, Tarsal tunnel syndrome, Mixed pain, Neuropathic pain, Shockwaves

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