ED ultrasound-guided posterior tibial nerve blocks for calcaneal fracture analagesia

Calcaneal fracture is a common injury that often results in severe, difficult-to-treat pain. Increasingly, emergency practitioners are asked to both improve pain management and reduce use of opioid pain relievers. Moreover, opioid monotherapy is often inadequate to safely control the pain of acute bone fractures. Ultrasound-guided nerve blocks integrated into a multimodal approach are increasingly recognized as the criterion standard for acute pain control in extremity trauma. We reviewed the neuroanatomy of the calcaneous and hypothesized that a selective posterior tibial nerve blockwould provide clinically significant relief for emergency department patients with acute calcaneal fracture pain. Herein, we report the first emergency department use of an ultrasound-guided posterior tibial nerve block for the management of acute pain from bilateral calcaneal fractures. This case illustrates our experience that the posterior tibial nerve block is an excellent therapeutic option for patients with acute calcaneal fracture pain worthy of further study.