Botox Injections for Plantar Fasciitis Treatment

The plantar fascia under the sole of the footThe plantar fascia

Following on from our post last month covering some recent research demonstrating the effectiveness of electro-acupuncture in the treatment of plantar fasciitis, a new study has been published in Foot and Ankle International which has found promising results in PF sufferers using a new form of treatment.

A group of researchers from the Autonomous University of Nuevo Leon in Mexico undertook the study, comparing the effect of Botox injections and the more traditional Steroid injections.

InjectionCorticosteroid (also known as Cortisone) injections have been used as a treatment for many chronic conditions, including plantar fasciitis for years. Corticosteroids are potent anti-inflammatories which may be administered by injection, orally or by a technique called iontophoresis. The main aim of a steroid injection is to reduce pain and inflammation sufficiently to allow a rehabilitation programme commence. However, they have been shown to have a short-term effect and to also increase the risk of tendon rupture.

Botox is a neurotoxic protein used more famously in cosmetic procedures to reduce fine lines and wrinkles. It does however have other medical uses, which include reducing excess sweating, chronic pain, neuropathy, headaches and migraines.

Botox works by decreasing muscle contraction through blocking nerve impulses. The protein is injected into the muscle tissue using a fine needle and so does not require local anaesthetic.

Recent Research

This latest research into the use of Botox versus steroids for the treatment of plantar fasciitis used 36 volunteers who had been suffering with plantar fasciitis for a minimum of three months, with no other injuries or complications and no previous therapeutic injections.

The participants were randomly assigned to one of two groups. The control grStretching the sole of the footoup received a corticosteroid injection into the medial plantar surface of the foot. The test group received three injections of Botox into the Gastrocnemius and Soleus calf muscles. Both groups were instructed to stretch the plantar fascia of the foot regularly.

Evaluation was performed over a period of 6 months, at 15 days, 1 month, 2 months, 4 months and 6 months post injections.  The Visual Analog Scale (VAS), Foot and Ankle Disability Index (FADI) and American Orthopedic Foot and Ankle Society (AOFAS) Score were used to evaluate the effects of treatment in both groups.

The results indicated that whilst initially there was no difference in perceived pain and disability between groups (at the 15 day follow-up), the Botox group began to show improvements by the 2 month mark with VAS scores of 1.9 ± 1.51 points, compared to 3.4 ± 1.24 for the control group. These improvements continued throughout the time frame of the study, with the Botox group reporting 1.1 ± 1.5 points at the 6 month point, where those in the steroid group continued to deteriorate, with a final score of 3.8 ± 1.15.

Conclusion

So, at first glance, Botox injections appear to be a promising form of treatment for plantar fasciitis. The desired effect is different to that of the more traditional steroid injection. Rather than treating the area of pain, inflammation and degeneration, the use of Botox injections targets one of the main causes of plantar fasciitis – tight calf muscles.  It is always preferable to treat the cause of an injury rather than the symptoms and so to me, this form of treatment makes sense.

My only question concerning the methodology of the study is why the participants were asked to stretch the plantar fascia alone and not the calf muscles? Increasing the calf muscle flexibility has been shown to be important in plantar fasciitis rehabilitation and to be far more effective than stretching the fascia itself. Perhaps the authors decided not to stretch the calf muscles as they did not want the possibility of calf stretching being responsible for any improvements.

As with all potential new treatments, further investigation is required. Studies with larger participant numbers should be undertaken, as well as studies comparing Botox injection only against a thorough plantar fasciitis physical therapy protocol.

Reference: Elizondo-Rodriguez J et al. Foot Ankle Int. 2013;34:8-14.

Carpal Tunnel Syndrome – Seasonal Symptoms?

Carpal Tunnel Syndrome is a wrist injury caused by compression of the median nerve, which results in pain at the wrist, radiating into the hand and neural symptoms such as tingling, numbness and weakness.

This time of year seems to bring out more cases than ever, mostly due to the increase in outdoor pursuits which put greater stress on the wrists. Sports such as tennis, and beach sports like volleyball, and even family games like Frisbee can result in wrist injuries, causing swelling and compression in the wrist. Other activities such as gardening can cause overuse wrist injuries which can trigger it off.

Carpal tunnel syndrome is most common in women. This is due to the generally smaller anatomy of the wrist area in females and also that it is common during pregnancy due to fluid retention.

The median nerve passes through the wrist in the ‘carpal tunnel’ and innervates the palm of the hand, the thumb, index and middle fingers, as well as the lateral side of the ring finger. The median nerve can become compressed (entrapped or pinched) within the carpal tunnel, causing the symptoms below:

  • A constant dull ache in the wrist and sometimes also the forearm.
  • Pain which radiates into the hand, thumb, index and middle fingers.
  • Neural signs such as tingling, burning or numbness.
  • Symptoms are worse at night.
  • Weakness in the fingers, especially on gripping.
  • Pain may occasionally be felt in the elbow or even the shoulder.

The cause of carpal tunnel syndrome varies. The nerve is compressed due to a lack of space in the tunnel through which it passes. This is often because of excess fluid, either swelling, or fluid retention, although sometimes can be more structural.

Here are the most common causes:

  • Pregnancy.
  • Traumatic wrist injuries which cause swelling – wrist sprains, fractures etc.
  • Overuse wrist injuries – RSI / tendonitis.
  • Arthritis.
  • Congenital – naturally narrower carpal tunnel.
  • Use of vibrating machinery.

In most cases, the treatment of CTS involves rest, using a wrist splint at night, and a doctor may prescribe a daily diuretic tablet to help reduce fluid retention.

If conservative measures fail, steroid injections are helpful in over 60% of cases. Acute pain may be felt at the time of injection and for up to 48 hours after the injection. Symptoms should ease within a few days.

If this is unsuccessful, then carpal tunnel release surgery is the next step for chronic cases. The procedure involves cutting the carpal ligament to create more space for the median nerve and other structures which pass through the tunnel, reducing compression and symptoms. Surgery is only offered in cases which have not responded to conservative treatment and steroid injections and which is not expected to clear naturally (i.e. after pregnancy).

Platelet Rich Plasma Therapy Effective in Plantar Fasciitis Treatment

A study has shown that Platelet Rich Plasma Therapy (PRP) is more effective thanSteriods Steroid injections in the treatment of Plantar Fasciitis. Results were reported earlier this week during the annual meeting of the American Academy of Orthopaedic Surgeons in San Francisco.

Up until now, Steroid (cortisone) injections were the most frequently used treatment for plantar fasciitis, once traditional treatments such as insoles, plantar fasciitis stretches and plantar fasciitis massage have failed.

The study used 36 patients, split into two groups. The first group received cortisone injections and the second, PRP therapy. Not only did the PRP group demonstrate a larger short-term improvement in symptoms, but they also maintained this improvement at 6 and 12 months after treatment. 12 months on, the cortisone groups’ symptoms had worsened considerably.

PRP Therapy involves removing a small sample of the patients own blood (usually from the arm) which is put into a centrifuge machine to separate the components. The plasma and platelets are then injected back into the patient, at the injury site.

Platelets are packed with growth and healing factors which help tissues to repair. In theory, this works as there is a greater concentration of platelets in the injured area.

As with all new studies, further research is needed, but this most recent paper has brought the use of PRP Therapy for Plantar Fasciitis treatment to the attention of medical professionals word-wide.

Visit Plantar Fasciitis on Sportsinjuryclinic.net for more detailed information on treating plantar fasciitis, including stretching, sports massage, taping and more.