Reduced foot pain after spasticity control with alcohol block in a patient with chronic hemiparetic stroke: a case report

Abstract

[Purpose] This study report a case of a patient with hemiparetic stroke who showed significantly reduced foot pain when ankle spasticity was reduced using nerve and motor point blocks with 20% ethyl alcohol. [Subject and Methods] A 58-year-old woman with left hemiparesis following intracranial hemorrhage five years previously presented with pain in the left fifth metatarsal head for two years (numeric rating scale[NRS]: 8). Erythema and edema were observed on the lateral aspect of the head of the fifth metatarsal bone. She was diagnosed with a Tailor’s bunion. Spasticity was observed in the left ankle plantar flexor and ankle supinator (Modified Ashworth Scale: 1+). Using 20% ethyl alcohol, a block in the medial and lateral motor branches to the gastrocnemius muscle of the left tibial nerve and the motor point of the left posterior tibialis muscle was performed. [Results] After the alcohol block, spasticity had almost disappeared and foot pain was significantly reduced (NRS: 1). Results from the foot pressure measurement system test showed foot contact pressure was highly distributed to the lateral forefoot pre-block. After the block, the distribution of foot contract pressure was similar to normal distribution. [Conclusion] Clinicians should consider the possibility that spasticity can contribute to foot pain.

Localization of the Nerve Entry Points of Thigh Adductor Muscles by Spiral Computed Tomography: A Novel Anatomical Guide for Chemical Neurolysis in Treating Muscle Spasticity

“…The chemical neurolysis, injecting phenol or ethanol to nerve branches at their entries to muscles, could induce the denaturalization of the proteins on endolemma and axons and help to decrease the activity of local nerve-muscle interaction, therefore preventing muscle contracture and improving the gait (Kocabas et al, 2010;Lee et al, 2011;Karri et al, 2017). This therapy is beneficial to patients by reducing muscle hyperactivity, increasing hip joint moving range, and improving perineal hygiene (Ghai et al, 2012;Yalcin et al, 2014;Chang, 2017). Although X-ray imaging, electrical stimulator, ultrasound, and other equipment are used in this procedure (Akkaya et al, 2010;Yoshida et al;Matsumoto et al, 2018), the clinical effect of this therapy is limited by the inaccuracy in finding the precise location of the blocking target.…”

Poststroke Pain

“…89 In addition, in the lower leg, spasticity usually occurs in the ankle plantar flexor and inverter; accordingly, the mechanical loading on the foot during standing or walking is abnormally distributed. 90,91 Loading imbalance can cause additional mechanical stress to the foot, which may cause pain in the joints or soft tissues. 90,91…”

“…90,91 Loading imbalance can cause additional mechanical stress to the foot, which may cause pain in the joints or soft tissues. 90,91…”

Forefoot disorders and conservative treatment

“…Forefoot disorders are extremely prevalent in the general population and can hinder patients’ activities of daily living. In cases where severe pain exists during gait, patients are reluctant to walk around, which can lead to poor physical function [1,2]. In many cases, forefoot disorders are caused by wearing ill-fitting or high-heeled shoes, altered foot alignment, and foot arthropathy [3,4].…”