Analyze the effects of botulinum toxin infiltration in the shortening of the aquiles-calcaneal-plantar system as a treatment for plantar fascitis

Abstract

The aquiles-calcaneal-plantar system shortening (ACPSS) is a frequent cause of ankle/foot pain. Pain can be located in the Achiles tendon or in the calcaneal insertion of the plantar fascia (PF), is the most frequent cause of chronic heel pain. Diagnosis is clinical given by heel pain that may vary in location, although calcaneus anteromedial region is the most common point. At physical examination it's important to evaluate the ankle range of motion. Silverskiold test informs about the relationship between the origin of the shortening if it's the gastrocnemius muscle or the soleus. Prospective study, from December 2016–December 2017, were selected 41 patients but 56 infiltrated legs, with PF resistant to conservative treatment, who had performed 2 or more of this treatments, without improvement: analgesics, insoles, physiotherapy and corticosteroids infiltration. All had clinical criteria for ACPSS. Patients were infiltrated in the gastrocnemius intern muscle with 100–150 IU of botulinum toxin, associated with triceps sural eccentric stretching 3/day, from the 4th day postinfiltration. Visual Analog Scale for pain (VAS) and the Foot Function Index - Spanish version (FFI) were evaluated. Patients were reviewed after 1, 4 and 6 months. The results were analyzed through the SPSS program; 66% (27 patients) were women between 40–60 years of age; 73% (30 patients) had received more than 3 treatments at the beginning of the study; 46% (19 patients) showed a treatment adherence of 2–3 times a day. Initial VAS was 7, one month later was 5 and 6 months after infiltration was 4. FFI scale one month after infiltration was 38% and sixth month was 28%; 78% (32 patients) recommended the treatment. Infiltration with botulinum toxin, allow to improve the length of the posterior compartment in patients with ACPSS as well as decrease in VAS, and the improvement in the functionality and limitation of the activities according to the FFI scale.