919 - Bilateral Tibial Nerve Stimulator Implantations for Chronic Plantar Fasciitis Pain

A 37-year-old male presented to the PM&R clinic for a several year history of bilateral foot pain secondary to plantar fasciitis. He failed multiple therapies in the past, including physical therapy, shoe inserts, shockwave therapy, and multiple plantar fasciotomies. He later developed sural nerve neuropathy due to scar tissue formation following bilateral gastrocnemius recession surgeries. His pain became debilitating to the point where he required forearm crutches, bilateral lower-extremity braces, and a wheelchair for ambulation/mobility. In the PM&R clinic, he underwent plantar fascia prolotherapy injections and bilateral tibial nerve blocks with significant pain relief and therefore was recommended for bilateral tibial nerve percutaneous nerve stimulator implants. He underwent ultrasound-guided placement of the right tibial nerve stimulator implant followed by the left tibial nerve stimulator implant 3 months later. Post-procedure, he reported significant pain control, functional improvement, and improved gait. He now walks independently without the use of assistive devices.

Discussions:

Peripheral nerve stimulation (PNS) has therapeutic potential to reduce pain in plantar fasciitis by placing subcutaneous leads adjacent to the tibial nerve. The branches of the tibial nerve supply sensation to the same areas in which plantar fasciitis typically presents as pain, which can suggest the use of tibial nerve stimulation as a successful pain modality. This patient had significant improvement in function and no longer required an assistive device for ambulation and ADLs.

Conclusions:

PNS can be an effective interventional pain modality in the setting of chronic plantar fasciitis with multiple failed conservative and/or invasive treatments. It has the potential to reduce pain and significantly improve function. Decreased pain can improve functional status and decrease physical barriers to activities of daily living.