Botox relieves plantar fasciitis pain

By Lynda Williams, Senior medwireNews Reporter

Botulinum toxin (BTX)A may be more effective than steroids for the treatment of plantar fasciitis, research suggests.

The 19 patients given a total of 250 U of BTX-A split between two medial and lateral calf muscle sites and the soleus had significantly faster and greater improvement than the 17 patients treated with intralesional dexamethasone (8 mg) plus 2% lidocaine (2 mL).

Although there was no significant difference between the BTX-A and steroid treatment groups at baseline for the visual analog scale (VAS) for pain (7.1 vs 7.7), patients given BTX-A had a significantly lower average score than steroid-treated patients at the 1-month check up (1.9 vs 3.4 points). Scores were also significantly lower at 2 (1.6 vs 3.6 ), 4 (1.5 vs 3.7 ), and 6 (1.1 vs 3.8) months.

Similarly, despite comparable Maryland Foot and Ankle scores at baseline, the BTX-A-treated patients had significantly greater improvement over the whole study than steroid-treated patients.

Although both patient groups experienced significant improvements of American Orthopaedic Foot and Ankle Society scores and Foot and Ankle Disability Index scores at 15 days after treatment, BTX-A was associated with a faster and more sustained treatment response than steroids.

The researchers note that all patients were shown dorsiflexion and plantarflexion stretching exercises to begin within a week of treatment.

"It is important to note that patients must perform plantar fascia stretching exercises to obtain a rapid and sustained improvement of plantar fasciitis," say Carlos Acosta-Olivo (Hospital Universitario "Dr Jose E Gonzalez," Universidad Autonomade Nuevo Leon, Monterrey, Mexico) and co-workers.

Due to the small study size, the team was unable to evaluate the impact of high body mass index on treatment outcome but notes that obesity is a significant risk factor for the development of plantar fasciitis.

Acosta-Olivo et al therefore conclude in Foot and Ankle International that this factor should be considered when evaluating patients.

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