SLR - February 2012 - David Harrison
Reference: Diaz-Llopis IV, Rodriguez-Ruiz CM, Mulet-Perry S, Mondejar-Gomez FJ, Climent-Barbera JM, Cholbi-Llobel F. Clin Rehabil Dec 1, 2011. [Epub ahead of print]
Scientific Literature Review
Reviewed by: David Harrison, DPM
Residency Program: Detroit Medical Center, Detroit, MI
Podiatric Relevance:
Plantar fasciitis is a common condition that is often encountered in the hospitals and health services. In 2010, corticosteroid injections were given a grade B recommendation for heel pain therapy by the American College of Foot and Ankle Surgeons. This article looks at Botulinum toxin type A as an alternative method of therapy that could be considered.
Methods:
This is a randomized controlled study where patients with a clinical diagnosis of plantar fasciitis made at least six months earlier were selected to enter a randomized, single-blind study of treatment with injections of botulinum toxin type A or corticosteroid. There were 28 patients in each treatment group. Patients were evaluated at one month using the Foot Health Square Questionnaire and those with no clinical response subsequently received a second injection with the drug of the other arm of the study, creating two new treatment groups. Re-evaluation was performed at six months.
Results:
The conclusion of this study was one month after injection there was a clear clinical improvement in both treatment groups, but it was greater in the botulinum toxin group, with a significant difference for the pain item. The botulinum toxin group reported 86 percent improvement while the corticosteroid group reported 64 percent improvement. At six months, patients treated with botulinum toxin type A had continued to improve in all items, whereas the corticosteroid group lost part of the improvement achieved at one month
Conclusions:
Botulinum toxin type A should be considered for the treatment of chronic plantar fasciitis in view of the improvement found at one month, and particularly at six months. Results indicate that this treatment clearly has better results than corticosteroid injections at the six month mark. It should also be noted that the botulinum toxin A group had better results in failure of treatment. Botulinum toxin A failed treatment 14% of the time while corticosteroid group failed 36 percent of the time. Further studies with larger samples are necessary to confirm these results.