Plantar fasciitis is the most frequent cause of chronic heel pain, leaving many sufferers unable to put their best foot forward for months at a time. Now a Mexican study suggests that physicians should turn to Botox rather than steroids to offer patients the fastest road to recovery. The research appears in the journal Foot & Ankle International.
Plantar fasciitis results when connective tissues on the sole of the foot, the plantar fascia, become painfully inflamed. Physicians may suggest various therapies for this condition, including applying steroids, regular stretching exercises or injecting botulinum toxin A (BTX-A), also known as Botox.
Steroid treatment is often used to treat plantar fasciitis, but it can cause complications. In an estimated 2-6 percent of patients, steroid treatment leads to the plantar fascia rupturing. Researchers from the Autonomous University of Nuevo Leon, Mexico devised a trial to compare steroid treatment with the botulinium toxin alternative, which works by blocking the neurotransmitter acetylcholine, weakening the muscles for several months.
The researchers set up a prospective, experimental, randomized, double-blinded, and controlled clinical trial, where patients were treated either with steroids or with Botox for their painful feet. Both groups were shown the same series of physical exercises to help their recovery.
Initially the two patient groups appeared to be recovering at a similar rate. However, the Botox group then took the lead in scores relating to foot pain, function and alignment. After six months, patients who received Botox injections were the clear winners, demonstrating more rapid and sustained improvement than their counterparts on the steroid regime.
"We found that a combination of BTX-A applications into the gastroc-soleus complex and plantar fascia stretching exercises yielded better results for the treatment of plantar fasciitis than intralesional steroids," says the study's corresponding author, Dr. Carlos Acosta-Olivo, adding that the plantar fascia stretching exercises were an important component of successful treatment.
A number of factors contribute towards the likelihood of developing plantar fasciitis, including tight hamstring muscles, or being overweight. The authors suggest incorporating measures of body mass index (BMI) into future studies. This was a relatively small-scale study, with just 36 patients completing the trial. However the results do indicate that given the risk of complications with steroids, Botox along with stretching exercises, could be the treatment of choice for this painful condition.
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"A Comparison of Botulinum Toxin A and Intralesional Steroids for the Treatment of Plantar Fasciitis: A Randomized, Double-Blinded Study" by Jorge Elizondo-Rodriguez, Yariel Araujo-Lopez, J. Alberto Moreno-Gonzalez, Eloy Cardenas-Estrada, Oscar Mendoza-Lemus, and Carlos Acosta-Olivo published January 2013 in Foot & Ankle International. fai.sagepub.com/content/34/1/8.full.pdf+html