Botox injections at the heel improve pain and function in patients with chronic plantar fasciitis, according to a new study in the Journal of Rehabilitation Medicine. Fifty patients with chronic heel pain and a diagnosis of plantar fasciitis were divided into two groups. The experimental group received injections of botulinum toxin type A at the insertion of the plantar fascia using ultrasound for guidance and were compared to a control group. The experimental group had significant decreases in pain at 3 weeks and 3 months compared to baseline and compared to the control group. The fat pad thickness was also measured and no change between baseline measurements was noted and there was no significant change compared to the control group. The authors concluded that botulinum toxin is effective at decreasing pain in patients with chronic plantar fasciitis without causing fat pad atrophy (1).
Plantar fasciitis is the tearing, initial inflammation and eventual deterioration of a ligament type structure which supports the arch. Plantar fasciitis can cause significant pain and disability. Botox causes paralysis of the foot musculature, resulting in increased flexibility of the small flexor muscles in the arch of the foot and also provides a localized analgesic effect. The duration of the effect can last approximately six months. Another study evaluated multiple injection sites. The researchers injected patients with chronic plantar fasciitis at two sites, at the tender area of the heel and in the arch and compared the results to a group injected with saline only. Significant improvements in pain were found in the group injected with botulinum toxin at 4 weeks and 8 weeks as compared to the group injected only with saline (2).
Botox has been used to effectively treat muscle spasticity and spastic foot disorders, such as spastic equinus which results in the foot sitting in a forced plantar flexed position. This is common in cerebral palsy and results in toe walking (3,4,5). Tight calf muscles are a contributing factor to many foot conditions, including plantar fasciitis (more on tight calves and foot conditions). Injecting botulinum toxin at the calf muscle to treat one of the causes of plantar fasciitis has been reported in a case study (6) and more recently at the American Academy of Pain Medicine’s annual meeting. A small study performed at George Washington University Hospital randomly assigned 10 patients with chronic plantar fasciitis into two groups. One group received injections of botulinum toxin at the insertion of the plantar fascia (heel bone area) and at the calf. The second group received injections only at the insertion of the plantar fascia. The two groups were compared at 1 month, 2 months and 3 months following the injections. The group receiving the injection at both the calf and the heel had significant improvement in pain compared to the group receiving the injection at only the heel.
Although botulinum toxin injections are not a novel treatment, the use of Botox in the treatment of chronic plantar fasciitis is a fairly new therapeutic approach. Critics of this treatment point out that injecting the toxin at the heel is not addressing the problem and merely offering short term relief. The plantar fascia is a ligament type structure, not a muscle, and the toxin does not have a known effect on the plantar fascia. Injections at the calf may show promise if tight calf muscles are a contributing factor to the development of the plantar fasciitis. Lastly, critics point out that there are no studies evaluating the long term efficacy of this treatment. More information on the diagnosis and treatment of plantar fasciitis.
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- Am J Phys Med Rehabil. 2006 Aug;85(8):699-703.
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