Abbasian M, Baghbani S, Barangi S, et al. Outcomes of Ultrasound-Guided Gastrocnemius Injection With Botulinum Toxin for Chronic Plantar Fasciitis. Foot Ankle Int. 2020 Jan;41(1):63-68. doi: 10.1177/1071100719875220. Epub 2019 Oct 5. (Original study)

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.

Discipline Area Score
Physician 5 / 7
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Comments from MORE raters

Physician rater

Although few patients were included in this study, this is a different approach for treating the few patients who do not improve with other conventional treatments.

Physician rater

Comparison of surgery with botulinum toxin should be the next step.

Physician rater

A well-structured study with definitive conclusions. It is a pity so few participants were included. We don´t know exactly the potency of the statistics, but the conclusions seem to have enough power. Although this is a novel technique, it is a variation of a previously described technique (botulin toxin injection), as acknowledged in the text. This is a good alternative for plantar fasciitis.
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