Ultrasound-Guided Dextrose Injection and Hydrodissection at the Soleus Fibular Enthesis: A Technical Report

This technical report describes an ultrasound-guided lesion-directed procedure at the soleus fibular enthesis in a patient with a clinically diagnosed proximal fibular bone stress injury and distal sensory symptoms.A 68-year-old female presented with persistent right Achilles-region pain, dorsal foot paresthesia, focal proximal fibular tenderness, and no foot drop; ankle eversion was pain-limited to Medical Research Council grade 4/5.Radiographs showed periosteal reaction at the symptomatic proximal fibula, interpreted clinically as a bone stress injury at the soleus attachment.With the patient prone, a 23-gauge, 6-cm needle was advanced in-plane from caudal to cranial toward the periosteal stress region.Aspiration was performed immediately before injection as a blood-return safety check.Five percent dextrose in water (D5W) was delivered to the symptomatic attachment region.The same needle was then redirected medially within the attachment-related treatment field, and additional D5W was used to produce visible separation of the adjacent soft-tissue plane.The common peroneal nerve (CPN) was neither contacted nor directly hydrodissected.A total of 30 mL of D5W was used per session for six sessions at two-week intervals.Reported global symptom improvement was approximately 50% after the first session and 80% after the sixth; final follow-up occurred three months after treatment completion, with no reported adverse events.The procedure therefore combined lesion-directed dextrose delivery with attachment-adjacent hydrodissection within one anatomical treatment region.The observed response does not establish treatment efficacy, a CPN-specific mechanism, enthesis regeneration, or fracture healing.