Botox – a Revolutionary Treatment for Plantar Fasciitis

What is Botox?

Botox is a common trade name for the neurotoxin called botulinum toxin. The neurotoxin is produced by a bacterium and then altered for clinical use. Small doses are used to purposely weaken or paralyze muscles or to block specific nerves. 

Specifically, a Botox injection hinders the release of acetylcholine, a neurotransmitter, in overactive muscles, inhibiting muscle contraction and function, and as a result, may alleviate pain. 

How is plantar fasciitis traditionally treated? 

Tight calves can prevent the ankle from fully bending up, which makes it difficult to place your heel on the floor while walking. Over time, this can cause problems, including toe and Achilles tendon pain, bunions, and flatfoot.

Tight calf muscles can also increase your risk of developing plantar fasciitis. When the calf muscle is tight, it pulls on the Achilles tendon, creating tension on the plantar fascia (the thick band of tissue that connects your heel bone to your toes). The result is a condition known as plantar fasciitis. Symptoms of plantar fasciitis often include sharp, stabbing, or achy heel pain that is not relieved by stretching exercises.

Therefore, severe cases of this debilitating condition have been traditionally treated with a variety of conservative plantar fasciitis therapies, such as rest, night splints, orthotics, and anti-inflammatory medications. For chronic plantar fasciitis, steroids, such as corticosteroid injections, may be recommended.

Some patients experience plantar heel pain relief with alternate non-surgical treatment options such as platelet-rich plasma (PRP) injections or extracorporeal shock wave therapy (ESWT).

Botox is generally recommended as a treatment modality for plantar fasciitis after other treatment options have failed. However, it is generally better than steroid injections as it doesn’t risk causing damage to the tissue. When combined with physical therapy, Botox can result in faster and more sustained improvement with less risk for tissue damage.

How can Botox be used in the treatment of plantar fasciitis? 

To treat plantar fasciitis pain, the podiatrists at University Foot & Ankle Institute inject Botox into the plantar fascia or calf muscle to reduce stiffness. The neurotoxin prevents your nerves from overstimulating the muscles by blocking the link between them. After a Botox injection, previously tight calf muscles and plantar fascia can stretch, relax, and grow. Postinjection, swelling, and inflammation may be decreased as well. 

Botox for plantar fasciitis can assist with function, relieve pain, and eliminate muscle spasms. It may also improve poor posture and the discomfort that can come with muscle pain, possibly preventing the need for surgical treatment.

Can botox help plantar fasciitis without surgery? 

Plantar fasciitis surgery, known as a plantar fasciotomy, involves surgically detaching the plantar fascia ligament from the heel bone. Releasing the ligament relieves tension, and therefore irritation and pain, but it can also come with drawbacks. 

After the plantar fasciitis operation, the connective tissue will start to heal. The thought is that as new tissue grows the plantar fascia will naturally be lengthened. Potential risks include slow wound healing, flattening of your foot's arch, or damage to the nerves. There is also the possibility that after plantar fascia surgery your chronic heel pain could return.

Usually, a plantar fascia operation is offered as a last resort for those who have not benefited from other, more conservative treatments, such as Botox injections.

What do the studies say? 

One study found that just over 90% of patients diagnosed with plantar fasciitis who received a Botox injection of 100 units reported being pain-free at their four-week follow-up appointment. Those who were not pain-free reported at least a 50% improvement in their symptoms. 

Another meta-analysis of randomized controlled trials reported that Botox injections for plantar fasciitis are potentially effective at improving function in the short term and pain in the long term, even though they could not physically reduce the thickness of plantar fascia. 

What can you expect after plantar fasciitis Botox injections? 

After botox injections, you may notice some tenderness along with pain and swelling near the injection site. However, discomfort is often minimal and lasts only a day or two. Some individuals experience pain relief within 24 hours, though the full effect can take up to two weeks. Most people report around four months of pain relief before another injection is needed.

Why UFAI is Your Best Choice for Plantar Fasciitis Treatment 

UFAI takes pride in being on the cutting edge of advanced treatment techniques, including Botox, for the treatment of plantar fasciitis. Our orthopaedic team has decades of combined experience managing the concerns and symptoms of plantar conditions. 

For a consultation, please call (877) 736-6001 or make an appointment online now.

University Foot and Ankle Institute is conveniently located throughout Southern California and the Los Angeles area. Our foot and ankle surgeons are available at locations in or near Santa Monica, Beverly Hills, West Los Angeles, Sherman Oaks, the San Fernando Valley, El Segundo, the South Bay, LAX, Calabasas, Agoura Hills, Westlake Village, Valencia, Santa Clarita, and Santa Barbara.

 

Botox for foot pain FAQs 

 

Does Botox have any side effects? 

As with all medicines, there are possible side effects. However, Botox is generally well tolerated, and the side effects are mild and temporary.

 

After a Botox treatment, you may experience some discomfort around the injection site, which should only last for a few days. Other side effects may include muscle weakness, tiredness, muscle aches and pains, flu-like symptoms, or headache.

 

What does Botox cost? 

Unfortunately, insurance companies do not usually cover treatments with Botox. The price varies for what type of treatment you need, which dictates how much Botox is needed.

 

Who is not a good candidate for Botox for the treatment of chronic plantar fasciitis? 

In general, those who are allergic to any of the ingredients in Botox injections or have underlying nerve or muscle disorders are not good candidates for Botox injections. The podiatrists at UFAI can review your circumstances and advise you on the best treatment plan. 

 

Sources:

Ahmad J, Ahmad SH, Jones K. Treatment of Plantar Fasciitis With Botulinum Toxin. Foot Ankle Int. 2017 Jan;38(1):1-7. doi: 10.1177/1071100716666364. Epub 2016 Oct 1. PMID: 27630253.

Babcock, M. S., Foster, L., Pasquina, P., & Jabbari, B. (2005). Treatment of pain attributed to plantar fasciitis with botulinum toxin a: a short-term, randomized, placebo-controlled, double-blind study. Am J Phys Med Rehabil, 84(9), 649–654. https://doi.org/10.1097/01.phm.0000176339.73591.d7

Carlos Acosta-Olivo, Luis E. Simental-Mendía, Félix Vilchez-Cavazos, Víctor M. Peña-Martínez, Jorge Elizondo-Rodíguez, Mario Simental-Mendía, Clinical Efficacy of Botulinum Toxin in the Treatment of Plantar Fasciitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials, Archives of Physical Medicine and Rehabilitation, Volume 103, Issue 2,2022, Pages 364-371.e2, ISSN 0003-9993, https://doi.org/10.1016/j.apmr.2021.10.003.