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Abstract
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Background and Aims Chronic pain caused by lack of blood flow is known as ischemic pain. Neurostimulation by causing a decrease of sympathetic output reduces vasoconstriction and improves blood flow. Parasympathetic stimulation has also been implicated in improving circulation in the extremities by causing arteriolar dilatation. We described a case of chronic pain and calcaneus skin ulcer due to an arteriovenous malformation (AVM) of the left calcaneus, resistant to surgical treatment and pulsed radiofrequency. The 53-year-old female presented with pain associated to heat sensation, pruritus, and allodynia in the left heel. The patient underwent endovascular embolization without relief. Pulsed radiofrequency and analgesic block of the left posterior tibial nerve provided temporary relief.
Methods The implantation of a neurostimulator electrode parallel to the left posterior tibial nerve, next to the internal malleolus, under ultrasound guidance occurred without complications.
Results The interventions resulted in significant pain relief, with the maximum visual analog scale (VAS) decreasing from 8/9 to 1 with four hours of neurostimulation daily. The calcaneus skin ulcer underwent excellent evolution as shown in figure 1.
Conclusions This case underscores the importance of a multidisciplinary approach in managing pain and cutaneous manifestations related to AVMs. Neurostimulation’s emerge as effective therapeutic options for AVMs neuropathic chronic pain, offering promising outcomes for patients resistant to conventional treatments.
Cutaneous aspect of the arteriovenous mallformation
Neurostimulation of the left the posterior tibial nerve