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.
Corticosteroid (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.
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 group 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.
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.