Topical sevoflurane: analgesic management in a marathon runner with plantar fasciitis

Abstract

We present a case of a Caucasian adult marathon runner with a 3-month history of severe unilateral pain in the left heel. Magnetic resonance imaging showed an enthesitis of the plantar fascia. His baseline VAS score was 1/10, but this increased to 7/10 post-exercise, and not alleviated by non-invasive treatments. Initially, patient-directed treatments consisting of rest, ice massage, oral analgesics, diclofenac gel, and stretching techniques for several weeks. His primary goal was to return to running marathons without symptoms. A sevoflurane 0.5% gel preparation was topically applied in the affected area at doses of 0.25–0.5 mL/cm2, resulting in a pain-free region shortly after the application (VAS score 0/10), thus enabling normal physical activity for up to 60 min, without further damage to the plantar fascia. The novel use of topical sevoflurane gel in the management of PF pain is reported and discussed herein.