Botulinum toxin (BTX)A may be more effective than steroids for the treatment of plantar fasciitis, research suggests.
The 19 patients given a total of 250 U of BTX-A split between two medial and lateral calf muscle sites and the soleus had significantly faster and greater improvement than the 17 patients treated with intralesional dexamethasone (8 mg) plus 2% lidocaine (2 mL).
Although there was no significant difference between the BTX-A and steroid treatment groups at baseline for the visual analog scale (VAS) for pain (7.1 vs 7.7), patients given BTX-A had a significantly lower average score than steroid-treated patients at the 1-month check up (1.9 vs 3.4 points). Scores were also significantly lower at 2 (1.6 vs 3.6 ), 4 (1.5 vs 3.7 ), and 6 (1.1 vs 3.8) months.
Similarly, despite comparable Maryland Foot and Ankle scores at baseline, the BTX-A-treated patients had significantly greater improvement over the whole study than steroid-treated patients.
Although both patient groups experienced significant improvements of American Orthopaedic Foot and Ankle Society scores and Foot and Ankle Disability Index scores at 15 days after treatment, BTX-A was associated with a faster and more sustained treatment response than steroids.
The researchers note that all patients were shown dorsiflexion and plantarflexion stretching exercises to begin within a week of treatment.
"It is important to note that patients must perform plantar fascia stretching exercises to obtain a rapid and sustained improvement of plantar fasciitis," say Carlos Acosta-Olivo (Hospital Universitario "Dr Jose E Gonzalez," Universidad Autonomade Nuevo Leon, Monterrey, Mexico) and co-workers.
Due to the small study size, the team was unable to evaluate the impact of high body mass index on treatment outcome but notes that obesity is a significant risk factor for the development of plantar fasciitis.
Acosta-Olivo et al therefore conclude in Foot and Ankle International that this factor should be considered when evaluating patients.
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