Beyond the Operating Room: Ultrasound-Guided Tibial Nerve Block for Plantar Wound Care in a Desert Ultramarathon

Severe plantar lesions are common during multistage desert ultramarathons and may require debridement and sequential dressing in austere field clinics. These procedures can be intensely painful because blistering, maceration, epidermal loss and sand contamination expose highly sensitive plantar tissue. We describe 3 runners treated during the Marathon des Sables who required advanced plantar wound care and received ultrasound-guided tibial nerve block for procedural analgesia. In each case, an isolated tibial nerve block was performed at the medial ankle using 8 mL of 1% lidocaine without epinephrine. The block produced effective plantar analgesia within approximately 10 min, allowing cleansing, debridement, and definitive dressing without pain. No immediate complications occurred. Sensory effects resolved after approximately 1 h, and all 3 runners completed the race. These cases suggest that ultrasound-guided tibial nerve block may be a practical, selective analgesic technique for plantar wound care in selected wilderness and endurance-event settings when performed by trained clinicians with appropriate safety planning.