Botulinum Toxin Treatment of Plantar Fasciitis (Plantar Fasciopathy)

Abstract

Plantar fasciitis/fasciopathy (PF) is a common problem which affects two million people in the USA and 10 % of runners. The symptoms of heel pain and foot discomfort can interfere with daily functions and are often disabling in the chronic form of PF. Commonly used treatments for symptoms of plantar fasciitis include stretching, taping, night splints, orthosis, nonsteroidal anti-inflammatory medications, iontophoresis, steroid injections, ultrasound extracorporeal and intracorporeal shock waves, acupuncture, and cryosurgery. With most of these approaches, improvement is short lived, and some approaches (i.e., shock wave therapy) are very painful and often require prior nerve block. Furthermore, injection of steroids can cause rupture of the plantar fascia. Clearly, an effective and safe therapeutic approach without substantial side effect is very much needed for PF. Local injection of botulinum toxin A is a relatively novel treatment for PF. The results of two double-blind, placebo-controlled studies have supported its efficacy (level B). A comparator-blinded study has shown that BoNT-A is more effective than betamethasone in relieving pain and improving function at 6 months. Furthermore, the positive effect of ona- and abobotulinumtoxinA lasted often beyond 6 months, and the injections caused no side effects. In this chapter, various therapeutic approaches for management of PF are presented with emphasis on botulinum toxins and their advantages.