Randomized controlled study comparing clinical outcomes after injection botulinum toxin type A versus corticosteroids in chronic plantar fasciitis
Keywords:Botulinum toxin, Outcome, Plantar fasciitis, Pain
Background: The plantar fascia is a common condition, for which there is no consensus on the best treatment option. The aim of this study is to compare the pain and fascia thickness outcomes of patients treated with botulinum toxin A injection versus corticosteroids injection.
Methods: 50 patients of plantar fasciitis randomly received injections of either botulinum toxin A (100 units in 2.5 ml normal saline) or methylprednisolone (2 ml of 40 mg/ml) under ultrasonographic guidance. Patients were assessed for pain using the visual analogue scale (VAS) and fascia thickness at baseline, 1 and 3 week, 3, 6 and 12 months post injection. Patients in the two treatment groups were compared for pain scores and thickness at each follow up.
Results: There were no significant differences in the patients in both the groups at baseline. Patients in both the groups had significant improvement in VAS pain scores over a 12 months follow- up. At the end of the study (12 month follow up), the VAS pain score was significantly lower in the group of patients who received botulinum toxin A (1.68±0.62 vs. 4.72±1.02, p value=0.001). There was a significantly less plantar fascia thickness in the group of patients who received botulinum toxin as compared to those who received corticosteroids at the 3 week, 3 month, 6 month and 1 year follow up.
Conclusions: Better clinical outcomes were observed with botulinum toxin type A as compared to corticosteroids. Similar studies need to be replicated with larger sample sizes before this can be offered as a standard treatment for plantar fasciitis patients.
Hicks JH. The mechanics of the foot, II: the plantar aponeuro- sis and the arch. J Anat. 1954;88(1):25-30.
Clement DB, Tauton JE, Smart GW, McNicoll KL. A survey of overuse running injuries. Phys Sports Med. 1981;9:47–58.
Clement DB, Tauton JE, Smart GW and McNicoll KL. A survey of overuse running injuries. Phys Sportsmed. 1981;9:47–58.
Gollwitzer H, Saxena A, DiDomenico LA, Galli L, Bouché RT, Caminear DS, et al. Clinically relevant effectiveness of focused extracorporeal shock wave therapy in the treatment of plantar fasciitis:a ran- domized, controlled multicenter study. J Bone Joint Surg. 2015;97(9):701-8.
Monto RR. Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis. Foot Ankle Int. 2014;35(4):313-8.
Wheeler P, Boyd K, Shipton M. Surgery for patients with recal- citrant plantar fasciitis: good results at short-, medium-, and long-term follow-up. Orthop J Sports Med. 2014;2(3):2325967114527901.
Sammarco GJ, Helfrey RB. Surgical treatment of recalcitrant plantar fasciitis. Foot Ankle Int. 1996;17(9):520-6.
Babcock MS, Foster L, Pasquina P, Jabbari B. 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. 2005;84(9):649-54.
Torda C, Wolff HG. On the mechanism of paralysis result- ing from toxin of Clostridium botulinum:the action of the toxin on acetylcholine synthesis and on striated muscle. J Pharmacol Exp Ther. 1947;89(4):320-4.
Mustafa G, Anderson EM, Bokrand-Donatelli Y, Neubert JK, Caudle RM. Anti-nociceptive effect of a conjugate of sub- stance P and light chain of Botulinum neurotoxin type A. Pain. 2013;154(11):2547-53.
Crawford F, Thomson C. Interventions for treating plantar heel pain. Cochrane Database Syst Rev. 2003;3(3):CD000416.
Placzek R, Deuretzbacher G, Meiss AL. Treatment of chronic plantar fasciitis with Botulinum toxin A:preliminary clinical results. Clin J Pain. 2006;22:190–2.
Babcock MS, Foster L, Pasquina P, Jabbari B. 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. 2005;84:649–54.
Huang YC, Wei SH, Wang HK, Lieu FK. Ultrasonographic guided botulinum toxin type A treatment for plantar fasciitis:an outcome-based investigation for treating pain and gait changes. J Rehabil Med. 2010;42:136–40.
Peerbooms JC, Van Laar W, Faber F, Schuller HM, Van Der Hoeven H, Gosens T. Use Of Platelet Rich Plasma To Treat Plantar Fasciitis: Design Of A Multi Centre Randomized Controlled Trial. BMC Musculoskelet Disord. 2010;11:69.
Gollwitzer H, Saxena A, DiDomenico LA, Galli L, Bouché RT, Caminear DS, et al. Clinically relevant effectiveness of focused extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: a randomized, controlled multicenter study. JBJS. 2015;97(9):701-8.