The Efficacy of Botulinum Toxin vs. Corticosteroid for the Treatment of Refractory Plantar Fasciitis

Treatment of plantar fasciitis is not well described in the current literature, often making management difficult for both providers and patients. Recent literature has suggested potential use of Onabotulinumtoxin A (BTX-A) as an effective treatment to reduce pain and allow patients to return to their previous level of functional activity. The study will consist of veteran patients at the George E Wahlen Department of Veteran's Affairs (SLC VA) in Salt Lake City, UT. This pilot study aims to randomize patients with plantar fasciitis into current standard of care treatment with corticosteroid injection into the plantar fascia and experimental treatment with BTX-A injection into the flexor digitorum brevis cohorts. We predict that those who receive BTX-A injections will report better outcomes on the Numeric Pain Rating Scale (NPRS) as well as the Foot and Ankle Ability Measure (FAAM) when compared to those receiving corticosteroid. The results of this study could aid in providing evidence towards more reliable and beneficial treatment of plantar fasciitis.

Inclusion criteria

• Diagnosed increased pain when pressure applied at the medial calcaneal tubercle
• X-ray negative for calcaneal fractures or tumors
• Patient with plantar fasciitis who have failed 6 weeks of non-operative treatment

Exclusion criteria

• Prior botulinum toxin injections in the plantar fascia
• Any botulinum toxin injections in the past 3 months
• Cortisone injection in the plantar fascia in the previous 3 months
• Previous surgery on the plantar fascia
• Active workers compensation claim for plantar fasciitis
• Active infection or fever
• Botox or steroid allergy
• Pregnancy
• Current other treatment specific to the plantar fascia or intent to undergo during the trial