Comparison of Botulinum Toxin A, Corticosteroid, and Anesthetic Injection for Plantar Fasciitis
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2021;9(8):11 Foot Ankle Int. 2021 Mar;42(3): 305-313.What this means for my practice?
Results of this randomized controlled trial suggest that ultrasound-guided intralesional injection of Botulin-Toxin A can statistically significantly improve foot function at 24 weeks follow-up compared to an injection of ropivacaine only. Yet, this study was limited by the small sample size of less than 25 patients in each arm, the lack of placebo or conventional treatment control (i.e. physical therapy), and the short follow-up of 24 weeks in which >1 year are needed to understand long-term beneficial effects. Therefore, future randomized controlled trials with larger sample size of patients in each arm implementing a conventional treatment control and following patients for a minimum of 1 year are needed to confirm the findings of this study.
Study Summary
Seventy-one patients with ≥2 months of persisting heel pain at the origin of the plantar fascia unresponsive to conventional therapies were randomized to receive a single injection of ropivacaine (5 mL; n=23), an intra-lesional injection of betamethasone sodium phosphate (1 mL; n=25), or an intralesional injection of 200 U of botulinum toxin A (BoNT-A; n=23) injection, administered using ultrasound-guidance. The outcomes of interest included the following: pain using the Visual Analogue Scale (VAS) and foot function using the Maryland Foot Score (MFS), evaluated at 2 weeks post-treatment as well as 1, 3, and 6 months post-intervention. Furthermore, fascia thickness was evaluated and dorsiflexion which were measured at 24 weeks follow-up. Results of this study demonstrated that only a statistical significant difference was observed between the BoNT vs. ropivacaine group at week 24 for MFS (p=0.0387). No other statistical differences were detected for VAS pain, fascia thickness, nor dorsiflexion scores between the three groups (p>0.05 for all).
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