Metatarsalgia in a patient with chronic hemiparetic stroke managed with alcohol block of the tibial nerve: A case report

ABSTRACT

We report the case of a patient with a hemiparetic stroke whose metatarsalgia was successfully managed by reducing the spasticity of plantar flexor using neurolysis with 20% ethyl alcohol. A 57-year-old female patient with left hemiparesis following an infarct of the right corona radiata and basal ganglia one year previously presented with pain (numeric rating scale 7) in the forefoot under the second to fourth metatarsal heads for six months. We diagnosed her with metatarsalgia and considered that the forefoot pain was associated with mechanical stress around the metatarsal head due to the spasticity (Modified Ashworth Scale 1+) of the ankle plantar flexor. We performed neurolysis of the medial and lateral motor branches of the tibial nerve to the gastrocnemius muscle with 20% ethyl alcohol. After the alcohol block, foot pain and spasticity significantly reduced (numeric rating scale 1; Modified Ashworth Scale 0). Moreover, this effect persisted for at least three months. Clinicians should consider the possibility that spasticity can contribute to the development of foot pain in a patient with stroke.