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Babcock MS, Foster L, Pasquina P, Jabbari B: Treatment of pain attributed to plantar fasciitis with botulinum toxin A: A short-term, randomized, placebo-controlled, double-blind study. Am J Phys Med Rebabil 2005;84:649-654.
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OBJECTIVE:: To investigate the effect of botulinum toxin A on associated pain and functional impairment of refractory plantar fasciitis. DESIGN:: This is a randomized, double-blind, placebo-controlled study of 27 patients (43 feet) with plantar fasciitis. Block randomization was performed using computer software. In patients with bilateral symptoms of comparable severity, botulinum toxin A was injected in one foot and saline in the other foot. The treatment group received a total of 70 units of botulinum toxin A divided into two sites per foot. One of the two sites was the tender area in the medial aspect of the heel close to the calcaneal tuberosity (40 units), and the other was in the arch of the foot between an inch anterior to the heel and middle of the foot (30 units). The placebo group received the same volume of normal saline. Main outcome measures included: Pain Visual Analog Scale, Maryland Foot Score, Pain Relief Visual Analog Scale, and pressure algometry response. Patients were assessed before injection, at 3 wks, and at 8 wks. RESULTS:: The study revealed statistically significant changes in the treatment group. Compared with placebo injections, the botulinum toxin A group improved in all measures: Pain Visual Analog Scale (P < 0.005), Maryland Foot Score (P = 0.001), Pain Relief Visual Analog Scale (P < 0.0005), and pressure algometry response (P = 0.003). No side effects were noted. CONCLUSIONS:: Botulinum toxin A injection for plantar fasciitis yields significant improvements in pain relief and overall foot function at both 3 and 8 wks after treatment.
Based on recent results in chronic lateral epicondylitis we decided to investigate the efficacy of Botulinum toxin A (BTX-A) for treatment of chronic therapy resistant plantar fasciitis. Nine patients with an average duration of symptoms of 14 months and at least two prior conservative treatments received a one injection of 200 units of BTX-A (Dysport(R)) subfascially into the painful area. The patients documented pain at rest and during weight-bearing after 2, 6, 10 and 14 weeks by a visual analogue scale. A significant reduction of pain during weight-bearing to about 50% was seen 6 weeks after injection. The effect was still present at the latest follow-up of 14 weeks. Similarly, the pain at rest was reduced to less than half of the initial value at any follow-up. All patients were satisfied and did not require further treatment.
I don't know much about botox a other than it effects ACH at the neuro-muscular synapse and hence inhibits muscle function. Given that the plantar fascia isn't a muscle, what effect is the botox having here, is it simply acting on the pain receptors? Or does this work suggest that pain may be coming from the plantar intrinsics originating in this area?
__________________ Science is the antidote to the poison of enthusiasm and superstition
Botox is also said to do well for hyperhidrosis at the plantar aspect.It is supposed to work for about 6 months for 1 injection.I have no experience with this.
An originally ambulatory 18-yr-old woman with spastic left hemiplegic cerebral palsy developed left plantar fasciitis with a gradual loss of function requiring use of a wheelchair. Her symptoms were resistant to physical therapy. Two hundred units of botulinum toxin A was diluted in 4 mL of saline and injected into the gastrocnemius. Three milliliters of autologous blood was injected into the plantar fascia. She reported decreased pain at 3 days postinjection. At 10 days, she had no pain on walking. Dorsiflexion increased and Ashworth and Tardieu improved. A stretching program was taught and a better-fitting night splint was obtained. At 21 days, she exhibited no pain and increased dorsiflexion. Autologous blood injection combined with botulinum toxin A may be an alternative treatment for resistant plantar fasciitis accompanied by spasticity. Our hypothesis is that chronic plantar fasciitis is a degenerative condition and thus is relieved when a mild inflammatory process is created that leads to healing.
Treatment of Chronic Plantar Fasciitis with Botulinum Toxin A - An Open Pilot Study on 25 Patients with a 14-Week-Follow-up
[Article in German]
Placzek R, Holscher A, Deuretzbacher G, Meiss L, Perka C. Z Orthop Ihre Grenzgeb. 2006 Jul-Aug;144(4):405-9.
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AIM: The conservative and operative treatments of plantar fasciitis tend to be tedious. Unsatisfactory results are common in chronic cases. This study was performed in order to test the hypothesis that the analgesic and anti-inflammatory effect of a single injection of Botulinum toxin A (BoNT A) induces a significant reduction of symptoms.
METHOD: 25 patients were included and followed-up for 14 weeks. Prior to injection, all of them had undergone at least two trials of conservative treatment. To determine the optimal treatment dose, 6 patients were injected subfascially with 100 units BoNT A (Dysport(R)), another 6 with 200 units BoNT A. As result of this pre-trial, another 13 patients were treated with the higher dose. The patients documented maximum pain and continuous pain on a visual analogue scale. The strength of the lower leg and foot muscles was clinically assessed.
RESULTS: A significant reduction of maximum and continuous pain was seen 2 weeks after injection in the group of 19 patients treated with 200 units BoNT A and persisted until the end of the follow-up. Adverse effects such as weakness of the muscles or systemic reactions have not been observed.
CONCLUSION: This pilot study shows the efficacy of a single application of 200 units BoNT A as a treatment option for chronic plantar fasciitis.
Botulinum toxin and plantar fasciitis
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