Efficacy of Ultrasound-Guided Tibial Nerve Block Combined With Shock Wave in the Treatment of Plantar Fasciitis: A Retrospective Cohort Study.

OBJECTIVE: To evaluate the effectiveness of ultrasound-guided tibial nerve block (TNB) with extracorporeal shock wave therapy (ESWT) versus ESWT alone or ESWT with fascial injection (FI) in plantar fasciitis (PF) of various courses. METHODS: This retrospective cohort study enrolled 209 PF patients (101 acute, 108 chronic), categorized into three groups: ESWT alone (Group A), ESWT-FI (Group B), and ESWT-TNB (Group C). Pain intensity and foot function were assessed via visual analogue scale (VAS) and American Orthopaedic Foot-Ankle Society (AOFAS) scores at baseline and 1-, 3-, and 6-month follow-ups. Subgroup analysis was performed stratified by calcaneal spur size. Multiple linear regression was applied to identify independent predictors of pain relief, and subgroup analysis stratified by calcaneal spur size was further performed to characterize treatment response across spur-length strata. RESULTS: For acute PF, Groups B/C yielded lower 1-month VAS vs A (mean difference = 1.094, 95% CI 0.759-1.429, p < 0.001; mean difference = 1.414, 95% CI 1.088-1.739, p < 0.001), with no intergroup differences at 6 months (all p > 0.05). In chronic PF, Groups B/C maintained superior VAS/AOFAS improvements at all timepoints; and Group C showed the largest 1-month VAS reduction vs A (mean difference = 2.998, 95% CI 2.662-3.333, p < 0.001). Regression identified calcaneal spur length as an independent negative predictor of pain relief (standardized β = -0.166, 95%CI -0.090-0.031, p < 0.001). Subgroup analysis revealed Group C optimal for spurs < 2.5 mm, comparable efficacy of B/C for 2.5-5 mm spurs, and superior ΔVAS in Group B for spurs > 5 mm. Only two transient heel numbness and five transient post-ESWT pain flares occurred, without severe adverse events. CONCLUSION: For chronic PF, ESWT combined with interventional therapy (especially TNB) provides greater clinical benefit. Heel spur length can serve as a predictor to guide individualized combination therapy (fascial injection or nerve block).