Metatarsalgia in a patient with chronic hemiparetic stroke managed with alcohol block of the tibial nerve: A case report
- Author:
Min Cheol Chang
- Publication Type:Case report
- Keywords:
Metatarsalgia;
spasticity;
alcohol block, tibial nerve;
20% ethyl alcohol;
stroke
- MeSH:
Metatarsalgia
- From:Neurology Asia
2017;22(3):267-270
- CountryMalaysia
- Language:English
-
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.
