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.

Keywords: Alcohol block; Spasticity; Tailor’s bunion.

Fig. 1.

(A) An image of the patient’s left foot shows erythema and edema in the fifth metatarsal head area. (B) The left foot X-ray showed that the fourth and fifth intermetatarsal angle was 7.7°

Fig. 2.

Foot pressure measurement image The foot pressure image of a normal foot and the images of the patient’s foot pressure showing alterations pre-alcohol block and post-alcohol block.