Deep peroneal nerve block may be a new treatment way for plantar fasciitis

Deep peroneal nerve block may be a new treatment way for plantar fasciitis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Deep peroneal nerve block may be a new treatment way for plantar fasciitis Ping Lin, Yujuan Ying, Chaoping Zhong, Yuanfang Zhu, Yang Gao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4186522/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 3 You are reading this latest preprint version Abstract Background Toe dorsiflexion is considered to be an important cause of plantar fasciitis, and the deep peroneal nerve (DPN) is the only nerve innervating the ankle joint and toe dorsiflexion. We hypothesized that blocking the DPN at the lower part of the tibia can reduce dorsiflexion of the toes at rest and in motion, thereby reducing plantar fascia tension, and will not affect the patient's normal activities. Methods Under ultrasound guidance, a DPN block was performed 2 cm above the ankle joint. Blocking twice a week for two consecutive weeks. The VAS pain scores at rest and movement were evaluated before and after treatment. The toe dorsiflexion angle change was observed in a static state, and the plantar fascia thickness changes before and after the block were observed by ultrasound to reflect the plantar fascia tension. Results We analyzed the location of DNP block on the specimen, and implemented DNP block in 18 patients with unilateral plantar fasciitis. DPN block reduces the heel pain in patients with plantar fasciitis both at rest and movement, the visual analog score (VAS) at rest at baseline with a MD (95% CI) of 3.77 (2.96 to 4.59) and at 2 weeks of treatment of 1.16 (0.62 to 1.71), the VAS at movement of baseline with a MD (95% CI) of (5.22 4.75 to 5.69) and at 2 weeks of treatment of 3.16 (2.43 to 3.89). After the block the angle of toe dorsiflexion at baseline with a MD (95% CI) of 20.50° (18.7 to 22.26) was decreased to 13.08° (10.88 to 15.27), and the thickness of plantar fascia at baseline with a MD (95% CI) of 4.56 mm (4.18 to 4.95) was increased to 5.53 mm (4.95 to 5.04), showing signs of decreased fascial tension. Conclusion From the perspective of balancing the biological force of the plantar fascia, using DPN block can improve the biomechanical position and tension of the plantar fascia to a certain extent to promote the recovery of the damaged fascia block. As far as we know, this treatment concept may be a new treatment way for plantar fasciitis. Plantar fasciitis Ultrasound Nerve block Biomechanics Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Plantar fasciitis is the most common cause of heel pain, and more than 15% of adults suffer from plantar fasciitis [ 1 ] , The plantar fascia is a layer of flat connective tissue that connects the heel and toes at the sole of the foot. It has the function of buffering the impact of force and maintaining the shape of the arch of the foot. If excessive and repeated tension is applied to the plantar fascia, it may cause minimally invasive injuries, leading to a condition called plantar fasciitis [ 2 ] . Plantar fasciitis is considered to be a degeneration of the fascia tissue, which is closely related to age and weight gain, as well as excessive dorsiflexion of the ankle and toes [ 3 ] . When the toes are dorsiflexed, the plantar fascia is stretched, causing the plantar fascia to increase in tension and at the same time the arch of the foot rises (Figure.1) . John Hicks used the Windlass Mechanism model to describe this special structure [ 4 ] . In addition, studies have found that the dorsiflexion angle of metatarsophalangeal joint is closely related to plantar fasciitis [ 3 , 5 , 6 ] . At present, The treatment of plantar fasciitis mainly includes invasive treatment and non-invasive physical therapy. The invasive treatment of plantar fasciitis is mainly based on local injection of anti-inflammatory and analgesic drugs, but the treatment effect is not ideal [ 7 ] . In non-invasive physical therapy, focused extracorporeal shock wave therapy (ESWT) is the most effective, but the severe pain accompanied by the treatment seriously affects the patient's treatment compliance and comfort, and the process of extracorporeal shock wave therapy is often supplemented with analgesic measures. Its exact treatment regimen, such a pulse number, energy number, shock wave frequency, focusing method, have not been widely confirmed by various clinical trials [ 8 , 9 ] . The current treatment methods mainly focus on the local inflammatory changes of the plantar fascia, and few studies have focused on the mechanical changes of the plantar fascia. Reducing the tension of the plantar fascia and providing conditions for injury repair may be a new therapeutic direction. Reducing the degree of dorsiflexion of the toes at rest or in motion, thereby reducing the tension of the plantar fascia, may be a new treatment strategy. The muscles that control dorsiflexion of the toes include the tibialis anterior and extensor pollicis longus and brevis, and these muscle movements are only governed by DPN [ 10 ] . DPN is branched from the common peroneal nerve, between the deep side of the Peroneus Longus and the neck of the fibula. Passing through the extensor digitorum longus, descending between the extensor digitorum longus and the tibialis anterior muscle, along the anterior side of the interosseous membrane and before the anterior tibial artery (Figure. 2A-B) [ 11 ] . There are many variations in the position of DPN around the ankle joint (Figure. 2C) , of which the lateral side of the anterior tibial artery is the most common [ 12 , 13 ] . In theory, blocking DPN can effectively reduce dorsiflexion of the toes. High plane DPN block could reduce the degree of toes dorsiflexion, but it will also affect ankle dorsiflexion to a certain extent. Although these are beneficial to reduce plantar fascia tension, they may also affect the patient's normal activities. Therefore, ankle joint plane DPN block stagnation may be an ideal treatment strategy for plantar fasciitis. Our study proposes a treatment strategy for ultrasound-guided DPN block at ankle joint level to relieve plantar fascia tension in patients with plantar fasciitis. Methods The choice of DPN block position This study is a method exploration and a single-arm self-controlled experiment. This study was approved by the Ethics Committee of the Zigong Fourth People's Hospital, all methods were performed in accordance with the relevant guidelines and regulations. We first analyzed the nerves and muscle structures related to toes dorsiflexion on the cadaver of the Anatomy Department of Southwest Medical University. Using Radiology Anatomy Atlas (RAA) Viewer (free release June 1, 2011) to obtain axial slices of human specimens at the ankle joint plane. [ 12 ] Ultrasound-guided DPN block Recruited patients with a clear diagnosis of unilateral plantar fasciitis. Participants with plantar fasciitis were required to exhibit the classic symptoms of plantar fasciitis (plantar heel tenderness, morning pain with the first few steps out of bed) and have had symptoms persisting longer than 6 weeks. The exclusion criteria included patients with coagulopathy, history of lower limb trauma, infection at the puncture site, and unconsciousness. Patients with ankle joint injuries or lower extremity surgery will be excluded, and patients with other plantar lesions will not be included. The basic demographic characteristics (gender, age and BMI) of the included patients were recorded, and all patients received pre-examination by ultrasound to determine the distribution of DPN. The examination method is that the patient relaxes the lower limbs, and uses a 13 − 6 MHz linear array ultrasound probe (Terason t3000, US) to scan about 2 cm above the ankle joint to determine the DPN position (Figure. 3A) . And then, the puncture point for the DPN block is further determined. If the DPN is located outside the anterior tibial artery, the lateral approach was used (Figure.3B) , otherwise, the medial approach was used for puncture (Figure. 3C) . Ultrasound scan uses the anterior edge of the tibia and the anterior tibial artery as the landmarks (Figure. 4A) . A 25G puncture needle was placed close to the DPN (Figure. 4B) , and 2-3ml of 0.5% ropivacaine is injected (Figure. 4C) . After the injection, the patient's feeling and movement loss are evaluated, and all patients are encouraged to move and work normally. Blocking twice a week for 2 consecutive weeks. The included patients were instructed in plantar fascia relaxation training, which did not restrict their daily activities. All patients were treated at rest in the morning, and no additional analgesic drugs were given to all patients. Outcome indicators include pain improvement before and after treatment, changes in toe dorsiflexion angle and changes in plantar fascia thickness before and after DPN block to reflect fascial tension. Outcome measure The visual analogue scale (VAS) was used to evaluate the degree of heel pain before and after 2 weeks of treatment, the pain levels in the resting state and the movement were evaluated. The patient was told to measure pain on a scale of 1 to 10, with a score of 0 indicating no pain and a score of 10 indicating unbearable pain. In order to verify the feasibility of our treatment method, we measured the dorsiflexion angle of the first metatarsophalangeal joint of patients. The measurement method is the angle between the tangent line and the vertical reference line between the lower edge of the great toe and the lower edge of the first metatarsophalangeal joint. In addition, we used ultrasound to examine the changes in the thickness of the plantar fascia at the front end of the calcaneus bone before and after the DPN block (when the fascia is stretched, it will become thinner to a certain extent, and the tension will be restored to a certain extent). The patient's feet were naturally pendulous after lying prone. The ultrasonic plane was parallel to the plantar, and the thickness of plantar fascia was measured 2 cm from the front end of the foot. Participants were positioned in prone with the examined foot over the edge of the examination table and the ankle in neutral, using an ultrasound probe to scan the plantar fascia about 2 cm at the tip of the root bone and measure the thickness of the fascia. Statistical analysis SPSS24.0 was used for statistical analysis, and the Mean ± Standard deviation (SD) was used to represent the measurement data of the normal distribution and 95% confidence interval (CI) was added. Mainly compare the toe dorsiflexion angle before and after DPN block, plantar fascia thickness, and the changes of pain score before and after treatment. The data conforming to the normal distribution uses the Paired Student-t test, if not, the Rank-sum test is used. P < 0.05 indicates that the difference is statistically significant. Result Ankle level DPN block may be an ideal position to balance the plantar fascia We have determined on the cadaver that the big toe dorsiflexion is made by the extensor hallucis longus and extensor hallucis brevis mainly but the tibialis anterior can contribute a lite bite. The other toes 2nd to 5th dorsiflexion is made by the Extensor digitorum longus and Extensor digitorum brevis. Performing a DPN block about 2 cm above the ankle joint will hardly affect the normal movement of the ankle joint, but it can block the movement of the entire instep muscles. This will greatly reduce the tension of the plantar fascia and provide a better recovery environment for the damaged fascia. At the same time, we observed that the DPN distribution at the block position we determined is relatively superficial. The details were summarized in (Table.1) . DPN block reduces heel pain in patients with plantar fasciitis to a certain extent In the end, a total of 18 patients with plantar fasciitis underwent DPN block on the affected side. The basic information of the included patients is summarized in (Table.2) . After a course of treatment (2 weeks), we found that DPN block significantly reduced the patient’s heel pain, both at rest and movement. Heel pain at two time points at rest and movement were shown in (Table. 3) . DPN block improves heel pain in patients with plantar fasciitis, which may be related to the delayed dorsiflexion of the toes We found that after the DPN block, the metatarsophalangeal joint dorsiflexion angle decreased (Figure. 5A-B) , and the thickness of the plantar fascia increased compared to before block. At the same time, we found that the position of the plantar fascia after blockade also decreased, indicating tension it has been reduced (Figure. 5C-D) , the specific details were summarized in (Table. 4) . During the entire treatment process, we did not observe the occurrence of adverse complications. We followed up patients 6 months after the end of treatment, as this was an initial exploration of a new treatment option. Among them, 4 patients (22.2%) had recurrent symptoms (mainly plantar pain after getting up in the morning and walking), and no discomfort complications were reported during follow-up. Discussion Although the etiology of plantar fasciitis may be multifactorial, the excessive mechanical load on the plantar fascia tissue is considered to be the root cause of the disease. Excessive stress in the fascia causes stress damage to the fascia near the attachment of the calcaneus. Continuous repetitive microtrauma is believed to inhibit the normal repair process [ 15 ] . By effectively connecting the expansion of the plantar fornix, the plantar fascia is in a state of being stretched during the stress buffering process. The proximal toe joint forms a structure similar to the Windlass Mechanism [ 4 ] . The toe dorsiflexion will cause traction, increasing fascial tension. Studies have found that metatarsophalangeal joints dorsiflexion is closely related to plantar fasciitis [ 6 , 16 , 17 ] . In this study, we propose a therapeutic strategy to reduce plantar fascia tension from plantar mechanical characteristics, We reduced the muscle tone of the muscles of the Anterior compartment of the leg and the muscles of the Dorsum of the foot by blocking the distal DPN. Although most patients' pain will be relieved within a year, while most people will seek treatment before then. At present, many treatment methods for plantar fasciitis have been proposed. Most patients choose conservative treatment, mainly physical therapy and the use of anti-inflammatory and analgesic drugs, but drug-related complications have to be taken into consideration, while it usually can only relieve symptoms, and not repair the damage of the plantar fascia, and hormone injections may lead to complications such as fracture of the plantar fascia and atrophy of the fat pad [ 7 ] . Focused extracorporeal shock wave therapy has long been considered the best treatment for plantar fasciitis, compared with corticosteroid injection, focused extracorporeal shock wave has many advantages such as non-invasive, low risk and fewer complications. In addition, extracorporeal shock wave therapy can reshape the tissue structure of plantar fascia, but it also has the disadvantages of long treatment cycle and high cost, and some patients are also accompanied by a certain degree of pain during the treatment [ 9 ] . Some scholars believe that foot orthotics and night splints can relieve the symptoms of plantar fasciitis to a certain extent, but additional orthopedic devices may affect the normal activities of patients [ 18 ] . Local injection in the heel can relieve pain in a short time, and the long-term treatment effect was not obvious [ 19 ] . In addition, surgical treatment is not considered an effective method to solve plantar fasciitis, and the results have high variability [ 7 ] . By analyzing the biomechanical causes of plantar fasciitis, we pioneered the use of ultrasound guidance to block DPN to reduce the traction of the dorsal muscles on the toes. We speculate that this will greatly reduce the stress on the plantar fascia. This treatment strategy may be bold, but through our practice we have found that this treatment method can create good low-stress conditions for the repair of fascia damage. We observed an increase in the thickness of the plantar fascia after DPN was blocked by ultrasound, and the position of the plantar fascia rose as a reference. These signs suggest that DPN retardation reduces the tension of the fascia by reducing dorsiflexion of the toes [ 20 ] . Measuring plantar fascia tension is very challenging [ 21 ] . and we cannot accurately monitor the specific tension changes before and after DPN block. Through the analysis of the exercise muscle group, we chose to block about 2cm above the ankle joint, which will not affect the ankle joint movement and preserve the function of the long extensor muscles, so the treatment strategy we proposed will not affect the patient’s normal activity. Previous studies have shown that plantar fasciitis is related to the thickness of plantar fascia, and when the thickness of plantar fasciitis is greater than 4 mm, it is considered to be an important feature in the diagnosis of plantar fasciitis. [ 5 , 6 ] It should be noted that the increased thickness of plantar fascia after DPN block in our study was a reflection of the changes in fascia thickness before and after DPN block, rather than an increase in the substantial structural thickness of plantar fascia. The decrease in fascial tension was indirectly reflected by the thickness of fascia before and after the blockade. However, it is important to note that the elasticity of fascia fibers and the degree of lesion in different patients should be evaluated before treatment. When a significant reduction in the echo of the plantar fascia in a two-dimensional ultrasound assessment indicates significant inflammation or a significant reduction in elastic fibers, this approach may be appropriate. Through our method, patients' plantar pain was significantly reduced, which may not be solely due to the reduction of plantar static membrane tension. In our clinical practice, we found that patients' plantar fascia ultrasound echoes gradually increased with the progress of treatment, which may be because the reduction of plantar fascia tension promoted the repair of fascia injury. Increased elastic fiber repair. It should be noted that DPN block for the treatment of plantar fasciitis is still in its infancy, and the feasibility of the treatment was only verified in a small sample study. This study is in the exploratory stage. This study has not yet compared DPN block with other treatments for plantar fasciitis. It is possible that subsequent controlled trials can be carried out to compare the feasibility of treatment. It may still need to carry out further large-sample randomized controlled trials for verification. Finally, we only evaluated the angle of dorsiflexion of the big toe, and did not measure the Angle of other feet toes. In further studies, it may be necessary to evaluate the mechanical changes in the patient's foot as a whole or to accurately measure the plantar fascia tension with specialized mechanical measuring equipment. Conclusion This treatment method has shown great potential for application from the perspective of balancing fascial mechanics to promote injury recovery. Ultrasound-guided DPN block may be a feasible method for the treatment of plantar fasciitis. Abbreviations Deep peroneal nerve (DPN) ; Tibialis anterior muscle (TAM) ; Extensor hallucis longus muscle (EHL); Extensor digitorum longus muscle (EDL); Extensor digitorum brevis muscle (EDB); Extensor hallucis brevis muscle (EHB); Peroneus longus muscle (PL); Peroneus brevis muscle (PB); Flexor digitorum longus muscle (FDL); Flexor hallucis longus muscle (FHL); Tibialis posterior muscle (TPM); Calcaneal tendon (CT); Visual analogue scale (VAS). Declarations Contributors P.L. concept proposal, plan design, picture sorting, data statistics and article writing; Y.Y. and C.Z. implementation of operations, data collection and statistics; Y.Z. and Y.G. participated in the conception, design, data acquisition, study image evaluations, and reporting. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Zigong Fourth People's Hospital. All methods were performed in accordance with the relevant guidelines and regulations. Consent for publication Not applicable. Informed Consent All the participants were above 16 years of age and informed written consent were obtained from all the patients. Availability of data and materials All the data sets supporting the results of this article are included within the article. Competing interests All the authors declare no competing interests. Funding No target funding report. Acknowledgement Thanks to Dr. Fu Jia and Dr. Hua Lu from the Affiliated Hospital of Southwest Medical University for their guidance on the operation method of this study; thanks to the Anatomy Department of Southwest Medical University for providing guidance on neuromuscular anatomy related to this study. In addition, I would like to thank all the patients who participated in this study for their willingness to participate in our exploratory treatment research. References Nahin RL. 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Tables Table.1 Muscle and innervation related to toe dorsiflexion Note: TAM: Tibialis anterior muscle; EHL: Extensor hallucis longus muscle; EDL: Extensor digitorum longus muscle; EDB: Extensor digitorum brevis muscle; EHB: Extensor hallucis brevis muscle Table. 2 Patient characteristics ( n =18) Age (year) Mean (SD) Sex (F/M) BMI (kg/m 2 ) Mean (SD) Duration of symptoms (moth) 55.33 (12.31) 10/8 25.41 (2.35) 3.2 (1.1) Note: F: Female; M: Male; BMI: Body mass index Table. 3 Patients VAS score changes ( n =18) VAS (rest) Mean (SD) 95% CI VAS (movement) Mean (SD) 95% CI Baseline 3.77 (1.62) 95% CI: 2.96 to 4.59 5.22 (0.94) 95% CI: 4.75 to 5.69 2 weeks 1.16 (1.09) 95% CI: 0.62 to 1.71 3.16 (1.46) 95% CI: 2.43 to 3.89 t 5.639 5.005 P-value ＜0.001 ＜0.001 Table. 4 Toe dorsiflexion angle and plantar fascia thickness before and after DPN block Outcomes n Before (mm) Mean (SD) 95% CI After (mm) Mean (SD) 95% CI t P-value Angle (°) 18 20.50 (3.55) 95% CI:18.73 to 22.26 13.08 (4.42) 95% CI:10.88 to 15.27 36.33 ＜0.001 Thickness (mm) 18 4.56 (0.77) 95% CI: 4.18 to 4.95 5.53 (0.98) 95% CI: 4.95 to 5.04 5.037 0.01 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4186522","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":286052868,"identity":"a4309bec-5a85-4b66-b307-945cbbcb3444","order_by":0,"name":"Ping Lin","email":"","orcid":"","institution":"Zigong Fourth People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ping","middleName":"","lastName":"Lin","suffix":""},{"id":286052869,"identity":"00a99d6f-e70d-4b28-964b-a4c758f93b77","order_by":1,"name":"Yujuan Ying","email":"","orcid":"","institution":"Zigong Fourth People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yujuan","middleName":"","lastName":"Ying","suffix":""},{"id":286052870,"identity":"941d3355-3eda-4d77-9108-cdcbaa4cac29","order_by":2,"name":"Chaoping Zhong","email":"","orcid":"","institution":"Fushun People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chaoping","middleName":"","lastName":"Zhong","suffix":""},{"id":286052871,"identity":"c4dee452-83b1-46cd-b95f-1013e9d1a177","order_by":3,"name":"Yuanfang Zhu","email":"","orcid":"","institution":"Zigong Fourth People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yuanfang","middleName":"","lastName":"Zhu","suffix":""},{"id":286052872,"identity":"dadd9605-ae45-4fc8-9655-b0e309aa3e09","order_by":4,"name":"Yang Gao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvUlEQVRIiWNgGAWjYBADOTb29gOkaTHm4zmTQJqWxHkSDgbEKZWPSH728Muf2vQ2CYYEhh8V2whrMbyRZm4sw3M8t0268QBjz5nbRGiZkWAmLSFxLLdN5kACM2MbUVrSv0lLGBxLZ5NIMCBOi7xEjpnkh4SaBOK1GPC8KZNmOHDAsA0YyAeJ8ot8e/o2yR9/6uTl29sPPvhRQYwtFxIYmHkYDoM5BwirB9nSf4CB8QdDHVGKR8EoGAWjYIQCAJzvPM57yBHuAAAAAElFTkSuQmCC","orcid":"","institution":"Zigong Fourth People's Hospital","correspondingAuthor":true,"prefix":"","firstName":"Yang","middleName":"","lastName":"Gao","suffix":""}],"badges":[],"createdAt":"2024-03-29 08:07:44","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4186522/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4186522/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54044693,"identity":"593d1aab-fe99-4ce9-b6b6-28dab9ff045f","added_by":"auto","created_at":"2024-04-03 18:48:53","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":75442,"visible":true,"origin":"","legend":"\u003cp\u003eA schematic diagram of the influence of toe dorsiflexion on the tension of the plantar fascia. \u003cstrong\u003e(A)\u003c/strong\u003e Normal condition; \u003cstrong\u003e(B)\u003c/strong\u003e The toes are excessively dorsiflexed.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4186522/v1/b5750f0bc3c40d122cf4262c.jpg"},{"id":54044695,"identity":"79558e1d-8719-40b6-8d1b-0ee6f34f1234","added_by":"auto","created_at":"2024-04-03 18:48:53","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":63345,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e(A-B)\u003c/strong\u003e Axial organization structure above the ankle joint. Extensor hallucis longus muscle (EHL), extensor digitorum longus muscle (EDL), Peroneus brevis muscle (PB, Flexor hallucis longus muscle (FHL), Flexor digitorum longus muscle (FDL), Tibialis anterior muscle(TAM) and Tibialis posterior muscle (TPM) for reference. DPN (yellow arrow), Anterior tibial artery (red arrow), Veins (green arrows);\u003cstrong\u003e(C) \u003c/strong\u003eFour common anatomical position variations of DPN.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4186522/v1/a23026a72278a55f5a261807.jpg"},{"id":54044694,"identity":"9b95d689-9b99-41e5-bd30-93e9b6f465e8","added_by":"auto","created_at":"2024-04-03 18:48:53","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":65202,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e(A) \u003c/strong\u003eDPN blocking point;\u003cstrong\u003e (B)\u003c/strong\u003eAnterior tibial artery lateral puncture method; \u003cstrong\u003e(C) \u003c/strong\u003eAnterior tibial artery medial puncture method.\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4186522/v1/fe50452ef96ea6202ce799e2.jpg"},{"id":54044696,"identity":"34642796-1dba-45a8-993d-65dcd9dc8106","added_by":"auto","created_at":"2024-04-03 18:48:53","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":69845,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e(A-C) \u003c/strong\u003eUltrasound images during DPN block operation,DPN (yellow arrow), Puncture needle (white arrow).\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4186522/v1/fad0f1baa72346a089e210d8.jpg"},{"id":54044697,"identity":"813d5bd4-e3d9-4a94-926d-9f9aff870d14","added_by":"auto","created_at":"2024-04-03 18:48:53","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":124024,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e(A)\u003c/strong\u003e The toe dorsiflexion angle before DPN block; \u003cstrong\u003e(B)\u003c/strong\u003eThe toe dorsiflexion angle is reduced after DPN block; \u003cstrong\u003e(C)\u003c/strong\u003e Ultrasound image of plantar fascia before DPN block; \u003cstrong\u003e(D)\u003c/strong\u003e After DPN block, plantar fascia is thickened and its position is elevated.\u003c/p\u003e","description":"","filename":"5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4186522/v1/9bebe3042578163b465defdf.jpg"},{"id":54045100,"identity":"a08c4742-0fcf-49ae-82bf-df34b2db62bd","added_by":"auto","created_at":"2024-04-03 18:56:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":694026,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4186522/v1/a5046c10-2469-4644-944a-0e59ec89c51d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Deep peroneal nerve block may be a new treatment way for plantar fasciitis","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePlantar fasciitis is the most common cause of heel pain, and more than 15% of adults suffer from plantar fasciitis \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e, The plantar fascia is a layer of flat connective tissue that connects the heel and toes at the sole of the foot. It has the function of buffering the impact of force and maintaining the shape of the arch of the foot. If excessive and repeated tension is applied to the plantar fascia, it may cause minimally invasive injuries, leading to a condition called plantar fasciitis \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Plantar fasciitis is considered to be a degeneration of the fascia tissue, which is closely related to age and weight gain, as well as excessive dorsiflexion of the ankle and toes \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. When the toes are dorsiflexed, the plantar fascia is stretched, causing the plantar fascia to increase in tension and at the same time the arch of the foot rises \u003cb\u003e(Figure.1)\u003c/b\u003e. John Hicks used the Windlass Mechanism model to describe this special structure \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. In addition, studies have found that the dorsiflexion angle of metatarsophalangeal joint is closely related to plantar fasciitis \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. At present, The treatment of plantar fasciitis mainly includes invasive treatment and non-invasive physical therapy. The invasive treatment of plantar fasciitis is mainly based on local injection of anti-inflammatory and analgesic drugs, but the treatment effect is not ideal \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. In non-invasive physical therapy, focused extracorporeal shock wave therapy (ESWT) is the most effective, but the severe pain accompanied by the treatment seriously affects the patient's treatment compliance and comfort, and the process of extracorporeal shock wave therapy is often supplemented with analgesic measures. Its exact treatment regimen, such a pulse number, energy number, shock wave frequency, focusing method, have not been widely confirmed by various clinical trials \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. The current treatment methods mainly focus on the local inflammatory changes of the plantar fascia, and few studies have focused on the mechanical changes of the plantar fascia. Reducing the tension of the plantar fascia and providing conditions for injury repair may be a new therapeutic direction. Reducing the degree of dorsiflexion of the toes at rest or in motion, thereby reducing the tension of the plantar fascia, may be a new treatment strategy.\u003c/p\u003e \u003cp\u003eThe muscles that control dorsiflexion of the toes include the tibialis anterior and extensor pollicis longus and brevis, and these muscle movements are only governed by DPN \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. DPN is branched from the common peroneal nerve, between the deep side of the Peroneus Longus and the neck of the fibula. Passing through the extensor digitorum longus, descending between the extensor digitorum longus and the tibialis anterior muscle, along the anterior side of the interosseous membrane and before the anterior tibial artery \u003cb\u003e(Figure. 2A-B)\u003c/b\u003e \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. There are many variations in the position of DPN around the ankle joint \u003cb\u003e(Figure. 2C)\u003c/b\u003e, of which the lateral side of the anterior tibial artery is the most common \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. In theory, blocking DPN can effectively reduce dorsiflexion of the toes. High plane DPN block could reduce the degree of toes dorsiflexion, but it will also affect ankle dorsiflexion to a certain extent. Although these are beneficial to reduce plantar fascia tension, they may also affect the patient's normal activities. Therefore, ankle joint plane DPN block stagnation may be an ideal treatment strategy for plantar fasciitis. Our study proposes a treatment strategy for ultrasound-guided DPN block at ankle joint level to relieve plantar fascia tension in patients with plantar fasciitis.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eThe choice of DPN block position\u003c/h2\u003e \u003cp\u003eThis study is a method exploration and a single-arm self-controlled experiment. This study was approved by the Ethics Committee of the Zigong Fourth People's Hospital, all methods were performed in accordance with the relevant guidelines and regulations. We first analyzed the nerves and muscle structures related to toes dorsiflexion on the cadaver of the Anatomy Department of Southwest Medical University. Using Radiology Anatomy Atlas (RAA) Viewer (free release June 1, 2011) to obtain axial slices of human specimens at the ankle joint plane.\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eUltrasound-guided DPN block\u003c/h2\u003e \u003cp\u003eRecruited patients with a clear diagnosis of unilateral plantar fasciitis. Participants with plantar fasciitis were required to exhibit the classic symptoms of plantar fasciitis (plantar heel tenderness, morning pain with the first few steps out of bed) and have had symptoms persisting longer than 6 weeks. The exclusion criteria included patients with coagulopathy, history of lower limb trauma, infection at the puncture site, and unconsciousness. Patients with ankle joint injuries or lower extremity surgery will be excluded, and patients with other plantar lesions will not be included. The basic demographic characteristics (gender, age and BMI) of the included patients were recorded, and all patients received pre-examination by ultrasound to determine the distribution of DPN. The examination method is that the patient relaxes the lower limbs, and uses a 13\u0026thinsp;\u0026minus;\u0026thinsp;6 MHz linear array ultrasound probe (Terason t3000, US) to scan about 2 cm above the ankle joint to determine the DPN position \u003cb\u003e(Figure. 3A)\u003c/b\u003e. And then, the puncture point for the DPN block is further determined. If the DPN is located outside the anterior tibial artery, the lateral approach was used \u003cb\u003e(Figure.3B)\u003c/b\u003e, otherwise, the medial approach was used for puncture \u003cb\u003e(Figure. 3C)\u003c/b\u003e. Ultrasound scan uses the anterior edge of the tibia and the anterior tibial artery as the landmarks \u003cb\u003e(Figure. 4A)\u003c/b\u003e. A 25G puncture needle was placed close to the DPN \u003cb\u003e(Figure. 4B)\u003c/b\u003e, and 2-3ml of 0.5% ropivacaine is injected \u003cb\u003e(Figure. 4C)\u003c/b\u003e. After the injection, the patient's feeling and movement loss are evaluated, and all patients are encouraged to move and work normally. Blocking twice a week for 2 consecutive weeks. The included patients were instructed in plantar fascia relaxation training, which did not restrict their daily activities. All patients were treated at rest in the morning, and no additional analgesic drugs were given to all patients. Outcome indicators include pain improvement before and after treatment, changes in toe dorsiflexion angle and changes in plantar fascia thickness before and after DPN block to reflect fascial tension.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eOutcome measure\u003c/h2\u003e \u003cp\u003eThe visual analogue scale (VAS) was used to evaluate the degree of heel pain before and after 2 weeks of treatment, the pain levels in the resting state and the movement were evaluated. The patient was told to measure pain on a scale of 1 to 10, with a score of 0 indicating no pain and a score of 10 indicating unbearable pain. In order to verify the feasibility of our treatment method, we measured the dorsiflexion angle of the first metatarsophalangeal joint of patients. The measurement method is the angle between the tangent line and the vertical reference line between the lower edge of the great toe and the lower edge of the first metatarsophalangeal joint. In addition, we used ultrasound to examine the changes in the thickness of the plantar fascia at the front end of the calcaneus bone before and after the DPN block (when the fascia is stretched, it will become thinner to a certain extent, and the tension will be restored to a certain extent). The patient's feet were naturally pendulous after lying prone. The ultrasonic plane was parallel to the plantar, and the thickness of plantar fascia was measured 2 cm from the front end of the foot. Participants were positioned in prone with the examined foot over the edge of the examination table and the ankle in neutral, using an ultrasound probe to scan the plantar fascia about 2 cm at the tip of the root bone and measure the thickness of the fascia.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eSPSS24.0 was used for statistical analysis, and the Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;Standard deviation (SD) was used to represent the measurement data of the normal distribution and 95% confidence interval (CI) was added. Mainly compare the toe dorsiflexion angle before and after DPN block, plantar fascia thickness, and the changes of pain score before and after treatment. The data conforming to the normal distribution uses the Paired \u003cem\u003eStudent-t\u003c/em\u003e test, if not, the \u003cem\u003eRank-sum\u003c/em\u003e test is used. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicates that the difference is statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Result","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eAnkle level DPN block may be an ideal position to balance the plantar fascia\u003c/h2\u003e \u003cp\u003eWe have determined on the cadaver that the big toe dorsiflexion is made by the extensor hallucis longus and extensor hallucis brevis mainly but the tibialis anterior can contribute a lite bite. The other toes 2nd to 5th dorsiflexion is made by the Extensor digitorum longus and Extensor digitorum brevis. Performing a DPN block about 2 cm above the ankle joint will hardly affect the normal movement of the ankle joint, but it can block the movement of the entire instep muscles. This will greatly reduce the tension of the plantar fascia and provide a better recovery environment for the damaged fascia. At the same time, we observed that the DPN distribution at the block position we determined is relatively superficial. The details were summarized in \u003cb\u003e(Table.1)\u003c/b\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eDPN block reduces heel pain in patients with plantar fasciitis to a certain extent\u003c/h2\u003e \u003cp\u003eIn the end, a total of 18 patients with plantar fasciitis underwent DPN block on the affected side. The basic information of the included patients is summarized in \u003cb\u003e(Table.2)\u003c/b\u003e. After a course of treatment (2 weeks), we found that DPN block significantly reduced the patient\u0026rsquo;s heel pain, both at rest and movement. Heel pain at two time points at rest and movement were shown in \u003cb\u003e(Table. 3)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003cb\u003eDPN block improves heel pain in patients with plantar fasciitis, which may be related to the delayed dorsiflexion of the toes\u003c/b\u003e \u003c/p\u003e \u003cp\u003eWe found that after the DPN block, the metatarsophalangeal joint dorsiflexion angle decreased \u003cb\u003e(Figure. 5A-B)\u003c/b\u003e, and the thickness of the plantar fascia increased compared to before block. At the same time, we found that the position of the plantar fascia after blockade also decreased, indicating tension it has been reduced \u003cb\u003e(Figure. 5C-D)\u003c/b\u003e, the specific details were summarized in \u003cb\u003e(Table. 4)\u003c/b\u003e. During the entire treatment process, we did not observe the occurrence of adverse complications. We followed up patients 6 months after the end of treatment, as this was an initial exploration of a new treatment option. Among them, 4 patients (22.2%) had recurrent symptoms (mainly plantar pain after getting up in the morning and walking), and no discomfort complications were reported during follow-up.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAlthough the etiology of plantar fasciitis may be multifactorial, the excessive mechanical load on the plantar fascia tissue is considered to be the root cause of the disease. Excessive stress in the fascia causes stress damage to the fascia near the attachment of the calcaneus. Continuous repetitive microtrauma is believed to inhibit the normal repair process \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. By effectively connecting the expansion of the plantar fornix, the plantar fascia is in a state of being stretched during the stress buffering process. The proximal toe joint forms a structure similar to the Windlass Mechanism \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. The toe dorsiflexion will cause traction, increasing fascial tension. Studies have found that metatarsophalangeal joints dorsiflexion is closely related to plantar fasciitis \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. In this study, we propose a therapeutic strategy to reduce plantar fascia tension from plantar mechanical characteristics, We reduced the muscle tone of the muscles of the Anterior compartment of the leg and the muscles of the Dorsum of the foot by blocking the distal DPN.\u003c/p\u003e \u003cp\u003eAlthough most patients' pain will be relieved within a year, while most people will seek treatment before then. At present, many treatment methods for plantar fasciitis have been proposed. Most patients choose conservative treatment, mainly physical therapy and the use of anti-inflammatory and analgesic drugs, but drug-related complications have to be taken into consideration, while it usually can only relieve symptoms, and not repair the damage of the plantar fascia, and hormone injections may lead to complications such as fracture of the plantar fascia and atrophy of the fat pad \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Focused extracorporeal shock wave therapy has long been considered the best treatment for plantar fasciitis, compared with corticosteroid injection, focused extracorporeal shock wave has many advantages such as non-invasive, low risk and fewer complications. In addition, extracorporeal shock wave therapy can reshape the tissue structure of plantar fascia, but it also has the disadvantages of long treatment cycle and high cost, and some patients are also accompanied by a certain degree of pain during the treatment \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Some scholars believe that foot orthotics and night splints can relieve the symptoms of plantar fasciitis to a certain extent, but additional orthopedic devices may affect the normal activities of patients \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. Local injection in the heel can relieve pain in a short time, and the long-term treatment effect was not obvious \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. In addition, surgical treatment is not considered an effective method to solve plantar fasciitis, and the results have high variability \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eBy analyzing the biomechanical causes of plantar fasciitis, we pioneered the use of ultrasound guidance to block DPN to reduce the traction of the dorsal muscles on the toes. We speculate that this will greatly reduce the stress on the plantar fascia. This treatment strategy may be bold, but through our practice we have found that this treatment method can create good low-stress conditions for the repair of fascia damage. We observed an increase in the thickness of the plantar fascia after DPN was blocked by ultrasound, and the position of the plantar fascia rose as a reference. These signs suggest that DPN retardation reduces the tension of the fascia by reducing dorsiflexion of the toes \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Measuring plantar fascia tension is very challenging \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. and we cannot accurately monitor the specific tension changes before and after DPN block. Through the analysis of the exercise muscle group, we chose to block about 2cm above the ankle joint, which will not affect the ankle joint movement and preserve the function of the long extensor muscles, so the treatment strategy we proposed will not affect the patient\u0026rsquo;s normal activity. Previous studies have shown that plantar fasciitis is related to the thickness of plantar fascia, and when the thickness of plantar fasciitis is greater than 4 mm, it is considered to be an important feature in the diagnosis of plantar fasciitis. \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e It should be noted that the increased thickness of plantar fascia after DPN block in our study was a reflection of the changes in fascia thickness before and after DPN block, rather than an increase in the substantial structural thickness of plantar fascia. The decrease in fascial tension was indirectly reflected by the thickness of fascia before and after the blockade. However, it is important to note that the elasticity of fascia fibers and the degree of lesion in different patients should be evaluated before treatment. When a significant reduction in the echo of the plantar fascia in a two-dimensional ultrasound assessment indicates significant inflammation or a significant reduction in elastic fibers, this approach may be appropriate. Through our method, patients' plantar pain was significantly reduced, which may not be solely due to the reduction of plantar static membrane tension. In our clinical practice, we found that patients' plantar fascia ultrasound echoes gradually increased with the progress of treatment, which may be because the reduction of plantar fascia tension promoted the repair of fascia injury. Increased elastic fiber repair.\u003c/p\u003e \u003cp\u003eIt should be noted that DPN block for the treatment of plantar fasciitis is still in its infancy, and the feasibility of the treatment was only verified in a small sample study. This study is in the exploratory stage. This study has not yet compared DPN block with other treatments for plantar fasciitis. It is possible that subsequent controlled trials can be carried out to compare the feasibility of treatment. It may still need to carry out further large-sample randomized controlled trials for verification. Finally, we only evaluated the angle of dorsiflexion of the big toe, and did not measure the Angle of other feet toes. In further studies, it may be necessary to evaluate the mechanical changes in the patient's foot as a whole or to accurately measure the plantar fascia tension with specialized mechanical measuring equipment.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis treatment method has shown great potential for application from the perspective of balancing fascial mechanics to promote injury recovery. Ultrasound-guided DPN block may be a feasible method for the treatment of plantar fasciitis.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eDeep peroneal nerve (DPN)\u003cstrong\u003e;\u0026nbsp;\u003c/strong\u003eTibialis anterior muscle (TAM)\u003cstrong\u003e;\u0026nbsp;\u003c/strong\u003eExtensor hallucis longus muscle (EHL); Extensor digitorum longus muscle (EDL); Extensor digitorum brevis muscle (EDB); Extensor hallucis brevis muscle (EHB); Peroneus longus muscle (PL); Peroneus brevis muscle (PB); Flexor digitorum longus muscle (FDL); Flexor hallucis longus muscle (FHL); Tibialis posterior muscle (TPM); Calcaneal tendon (CT); Visual analogue scale (VAS).\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eContributors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eP.L. concept proposal, plan design, picture sorting, data statistics and article writing; Y.Y. and C.Z. implementation of operations, data collection and statistics; Y.Z. and Y.G. participated in the conception, design, data acquisition, study image evaluations, and reporting.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of the Zigong Fourth People\u0026apos;s Hospital.\u0026nbsp;All methods were performed in accordance with the relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eInformed Consent\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the participants \u003cstrong\u003ewere above 16 \u0026nbsp;years of age and\u0026nbsp;\u003c/strong\u003einformed written consent were obtained from all the patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the data sets supporting the results of this article are included within the article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the authors declare no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo target funding report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgement\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThanks to Dr. Fu Jia and Dr. Hua Lu from the Affiliated Hospital of Southwest Medical University for their guidance on the operation method of this study; thanks to the Anatomy Department of Southwest Medical University for providing guidance on neuromuscular anatomy related to this study. In addition, I would like to thank all the patients who participated in this study for their willingness to participate in our exploratory treatment research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNahin RL. Prevalence and Pharmaceutical Treatment of Plantar Fasciitis in United States Adults. J Pain. 2018; 19: 885-896. DOI: 10.1016/j.jpain.2018.03.003.\u003c/li\u003e\n\u003cli\u003eHohmann E, Tetsworth K, Glatt V. Platelet-Rich Plasma Versus Corticosteroids for the Treatment of Plantar Fasciitis: A Systematic Review and Meta-analysis. The American journal of sports medicine. 2021; 49: 1381-1393. DOI: 10.1177/0363546520937293.\u003c/li\u003e\n\u003cli\u003eWearing SC, Smeathers JE, Urry SR, Hennig EM, Hills AP. The pathomechanics of plantar fasciitis. Sports Med. 2006; 36: 585-611. DOI: 10.2165/00007256-200636070-00004.\u003c/li\u003e\n\u003cli\u003eHicks JH. The mechanics of the foot. II. The plantar aponeurosis and the arch. 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Arch Orthop Trauma Surg. 2019; 139: 529-536. DOI: 10.1007/s00402-018-3071-1.\u003c/li\u003e\n\u003cli\u003eNakale NT, Strydom A, Saragas NP, Ferrao PNF Association Between Plantar Fasciitis and Isolated Gastrocnemius Tightness. Foot Ankle Int. 2018; 39: 271-277. DOI: 10.1177/1071100717744175.\u003c/li\u003e\n\u003cli\u003eWearing SC, Smeathers JE, Yates B, Sullivan PM, Urry SR, Dubois P. Sagittal movement of the medial longitudinal arch is unchanged in plantar fasciitis. Med Sci Sports Exerc. 2004; 36: 1761-1767. DOI: 10.1249/01.mss.0000142297.10881.11.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable.1\u0026nbsp;\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eMuscle and innervation related to toe dorsiflexion\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin:0in;text-align:center;font-size:14px;font-family:DengXian;line-height:150%;\"\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e\u003cimg 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\" width=\"843\" height=\"391\"\u003e\u003c/span\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cdiv align=\"center\" style=\"margin:0in;text-align:justify;font-size:14px;font-family:DengXian;\"\u003e\u003cbr\u003e\u003c/div\u003e\n\u003cp\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003eNote:\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003eTAM: Tibialis anterior muscle; EHL: Extensor hallucis longus muscle; EDL: Extensor digitorum longus muscle; EDB: Extensor digitorum brevis muscle; EHB: Extensor hallucis brevis muscle\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable. 2\u003c/strong\u003e Patient characteristics (\u003cem\u003en\u003c/em\u003e=18)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.846715328467155%\"\u003e\n \u003cp\u003eAge (year)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.153284671532848%\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003cp\u003e(F/M)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.62043795620438%\"\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.37956204379562%\"\u003e\n \u003cp\u003eDuration of symptoms (moth)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.846715328467155%\"\u003e\n \u003cp\u003e55.33 (12.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.153284671532848%\"\u003e\n \u003cp\u003e10/8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.62043795620438%\"\u003e\n \u003cp\u003e25.41 (2.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.37956204379562%\"\u003e\n \u003cp\u003e3.2 (1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: F: Female; M: Male; BMI: Body mass index\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable. 3\u003c/strong\u003e Patients VAS score changes (\u003cem\u003en\u003c/em\u003e=18)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth\u003e\u003cbr\u003e\u003c/th\u003e\n \u003cth\u003e\u003cbr\u003e\u003c/th\u003e\n \u003cth\u003e\u003cbr\u003e\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.62043795620438%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.5985401459854%\"\u003e\n \u003cp\u003eVAS (rest)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Mean (SD)\u003c/p\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.78102189781022%\"\u003e\n \u003cp\u003eVAS (movement)\u003c/p\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.62043795620438%\" valign=\"top\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.5985401459854%\"\u003e\n \u003cp\u003e3.77 (1.62)\u003c/p\u003e\n \u003cp\u003e95% CI: 2.96 to 4.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.78102189781022%\"\u003e\n \u003cp\u003e5.22 (0.94)\u003c/p\u003e\n \u003cp\u003e95% CI: 4.75 to 5.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.62043795620438%\" valign=\"top\"\u003e\n \u003cp\u003e2 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.5985401459854%\"\u003e\n \u003cp\u003e1.16 (1.09)\u003c/p\u003e\n \u003cp\u003e95% CI: 0.62 to 1.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.78102189781022%\"\u003e\n \u003cp\u003e3.16 (1.46)\u003c/p\u003e\n \u003cp\u003e95% CI: 2.43 to 3.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.62043795620438%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.5985401459854%\"\u003e\n \u003cp\u003e5.639\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.78102189781022%\"\u003e\n \u003cp\u003e5.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.62043795620438%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.5985401459854%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.78102189781022%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable. 4\u003c/strong\u003e Toe dorsiflexion angle and plantar fascia thickness before and after DPN block\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.318840579710145%\"\u003e\n \u003cp\u003eOutcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.514492753623188%\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.181159420289855%\"\u003e\n \u003cp\u003eBefore (mm)\u003c/p\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.355072463768117%\"\u003e\n \u003cp\u003eAfter (mm)\u003c/p\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.13768115942029%\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.492753623188406%\"\u003e\n \u003cp\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.318840579710145%\"\u003e\n \u003cp\u003eAngle\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(\u0026deg;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.514492753623188%\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.181159420289855%\"\u003e\n \u003cp\u003e20.50 (3.55)\u003c/p\u003e\n \u003cp\u003e95% CI:18.73 to 22.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.355072463768117%\"\u003e\n \u003cp\u003e13.08 (4.42)\u003c/p\u003e\n \u003cp\u003e95% CI:10.88 to 15.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.13768115942029%\"\u003e\n \u003cp\u003e36.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.492753623188406%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.318840579710145%\"\u003e\n \u003cp\u003eThickness (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.514492753623188%\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.181159420289855%\"\u003e\n \u003cp\u003e4.56 (0.77)\u003c/p\u003e\n \u003cp\u003e95% CI: 4.18 to 4.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.355072463768117%\"\u003e\n \u003cp\u003e5.53 (0.98)\u003c/p\u003e\n \u003cp\u003e95% CI: 4.95 to 5.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.13768115942029%\"\u003e\n \u003cp\u003e5.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.492753623188406%\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Plantar fasciitis, Ultrasound, Nerve block, Biomechanics","lastPublishedDoi":"10.21203/rs.3.rs-4186522/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4186522/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eToe dorsiflexion is considered to be an important cause of plantar fasciitis, and the deep peroneal nerve (DPN) is the only nerve innervating the ankle joint and toe dorsiflexion. We hypothesized that blocking the DPN at the lower part of the tibia can reduce dorsiflexion of the toes at rest and in motion, thereby reducing plantar fascia tension, and will not affect the patient's normal activities.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eUnder ultrasound guidance, a DPN block was performed 2 cm above the ankle joint. Blocking twice a week for two consecutive weeks. The VAS pain scores at rest and movement were evaluated before and after treatment. The toe dorsiflexion angle change was observed in a static state, and the plantar fascia thickness changes before and after the block were observed by ultrasound to reflect the plantar fascia tension.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eWe analyzed the location of DNP block on the specimen, and implemented DNP block in 18 patients with unilateral plantar fasciitis. DPN block reduces the heel pain in patients with plantar fasciitis both at rest and movement, the visual analog score (VAS) at rest at baseline with a MD (95% CI) of 3.77 (2.96 to 4.59) and at 2 weeks of treatment of 1.16 (0.62 to 1.71), the VAS at movement of baseline with a MD (95% CI) of (5.22 4.75 to 5.69) and at 2 weeks of treatment of 3.16 (2.43 to 3.89). After the block the angle of toe dorsiflexion at baseline with a MD (95% CI) of 20.50\u0026deg; (18.7 to 22.26) was decreased to 13.08\u0026deg; (10.88 to 15.27), and the thickness of plantar fascia at baseline with a MD (95% CI) of 4.56 mm (4.18 to 4.95) was increased to 5.53 mm (4.95 to 5.04), showing signs of decreased fascial tension.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eFrom the perspective of balancing the biological force of the plantar fascia, using DPN block can improve the biomechanical position and tension of the plantar fascia to a certain extent to promote the recovery of the damaged fascia block. As far as we know, this treatment concept may be a new treatment way for plantar fasciitis.\u003c/p\u003e","manuscriptTitle":"Deep peroneal nerve block may be a new treatment way for plantar fasciitis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-03 18:48:48","doi":"10.21203/rs.3.rs-4186522/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorAssigned","content":"","date":"2024-04-01T07:38:14+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-01T03:02:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Orthopaedic Surgery and Research","date":"2024-03-29T08:06:31+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7f7afb3c-7feb-43c4-9ecb-1184987aab2a","owner":[],"postedDate":"April 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-04-03T18:48:48+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-03 18:48:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4186522","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4186522","identity":"rs-4186522","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}