BACKGROUND: The objective of this study was to determine whether the injection of botulinum toxin A (BTA) in the medial head of the gastrocnemius muscle could yield improvements in function and disability in patients with chronic plantar fasciitis with follow-up 12 months after treatment.
METHODS: Thirty-two patients with chronic plantar fasciitis were included in the study and randomly allocated to the BTA and placebo groups. The visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) scores were used to evaluate pain levels pre- and postinjection as well as function of the foot, respectively. Patients were also asked to rate their treatment satisfaction 1 year after injection. The range of dorsiflexion was measured before and 12 months after the injection.
RESULTS: At the 12-month follow-up, the mean VAS decreased from 7.8 to 4 in the placebo group and from 8 to 0.33 in the BTA group. Furthermore, the mean AOFAS scores increased from 48.4 to 65.3 in the placebo group and from 45.5 to 90.6 in the BTA group. The postinjection scores in the BTA group were significantly higher than those in the placebo group (P < .001). Patient satisfaction in the BTA group was higher than that in the placebo group at the 12-month follow-up.
CONCLUSION: In patients with chronic plantar fasciitis, the use of BTA had a positive effect on improvement in pain and foot function 1 year after treatment.
LEVEL OF EVIDENCE: Level I, prospective randomized controlled trial.
Although a few patients were included in this study, it is a different approach to treat the few patients that do not improve with other conventional treatments.
Comparison of surgery with botulinum toxin should be the next step.
It is a well-structured work with definitive conclusions in the results. It is a pity that there are such the few numbers of participants included in the study. We exactly don´t know about the potency of the statistics in these conditions, but the conclusions seem to have enough power. Although the authors show a novel technique, the problem is that they show a variation (botulin toxin injection) in a technique previously described as they recognize in text. Conversely, they offer a good alternative to plantar fasciitis.