Comparison of Botulinum Toxin A, Corticosteroid, and Anesthetic Injection for Plantar Fasciitis.

Abstract

Plantar fasciitis is the most common cause of heel pain, and injection therapies are part of the treatment modalities. This study aimed to compare 2 intralesional injection therapies for plantar fasciitis: corticosteroid and botulinum toxin A, compared with a third control group using a local anesthetic. The clinical evolution, as well as changes in the thickness of the plantar fascia and ankle dorsiflexion, was evaluated. A randomized, controlled, double-blind trial design was used. Patients were divided into 3 groups: group 1, anesthetic only; group 2, corticosteroid; and group 3, botulinum toxin A (BoNT-A). We used an ultrasonographic evaluation to measure the plantar fascia thickness. The results were evaluated using the Maryland Foot Score and a 10-cm visual analog scale. Clinical scores were recorded at the beginning of the study, at 2 weeks, and at 1, 3, and 6 months. We evaluated 78 patients for study eligibility. The 3 intervention groups were homogeneous. All patients showed better clinical outcomes compared with their initial evaluations, without differences between groups at the end of follow-up. The thickness of plantar fascia diminished at the final evaluation, and ankle dorsiflexion was better compared with the initial values without difference between treatment groups. Considering all the evaluated outcomes, no significant differences between treatment groups were observed. The pain relief and functional improvement obtained with the different treatments was maintained during the 6-month follow-up. Level I, therapeutic study.