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Background and Aims A 53-year old gentleman with chronic left heel pain initially presented to Orthopaedics for left foot and heel pain. A surgical decompression of his tarsal tunnel was performed in 2019 with good relief of lateral heel pain. He subsequently developed worsening medial heel pain for which he was also seen by Rehabilitative Medicine and started on oral and topical analgesics, alongside lifestyle interventions. Extracorporeal shockwave therapy was performed but only provided temporary minor relief of pain. He was then referred to the chronic pain management clinic for consideration of further interventions in view of persistent heel pain interfering with his daily activities.

Conclusions The patient was reviewed in the pain management clinic in Jan 2024 and a bedside ultrasound of the heel showed mild tibial nerve swelling with no obvious Baxter nerve impingement. He was offered a diagnostic left medial plantar nerve block, which was done in clinic and provided good pain relief. A therapeutic left medial plantar nerve steroid injection was then performed in the same setting with administration of 20mg of perineurial triamcinolone under ultrasound guidance. The patient returned to clinic a month later in view of recurrence of pain after an initial pain-free period and was keen for further intervention. He was counselled appropriately and underwent ultrasound guided left medial plantar nerve stimulation, and pulsed radiofrequency neuromodulation with injection of 50u botulinum toxin, 20mg trialcinolone and 2ml of 0.5% Bupivacaine. He was reviewed at 1 and 2weeks post-procedure, and reported improvement of his heel pain by 40-50%.