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Botulinum toxin injections relieve plantar fasciitis pain.

ORLANDO --- Bothlinum toxin injected at the plantar fascia insertion and at the gastrocnemius-soleus complex relieved chronic plantar fasciitis pain better than did standard treatment, according to the findings of a small, randomized, controlled trial.

The hope is that such an approach will correct the underlying biomechanics that lead to plantar fasciitis, rather than simply address the symptoms of the condition by treating the site of the pain, said Dr. Mehul J. Desai of George Washington University Hospital in Washington.

Patients who were randomized to the novel treatment approach also experienced significant improvement in ankle, hip, and knee range of motion, Dr. Desai reported at the annual meeting of the American Academy of Pain Medicine.

Dr. Desai and his associates randomly assigned 10 patients with chronic unilateral plantar fasciitis and a mean age of 35 years into two groups. The five patients in the experimental treatment group received 50 U of botulinum toxin type A at the plantar fascia insertion, 50 U at the motor point of the soleus muscle, and 25 U at both the medial and lateral gastrocnemius motor points. Patients in the standard treatment group received 50 U of botulinum toxin type A at the plantar fascia insertion and saline at the three other sites.

The patients were assessed before the injections, and at 4, 8, and 12 weeks following treatment.

At study completion, patients in the experimental treatment group went from 7.9 points on a 10-point visual analog scale to 1.9 points. By comparison, patients who received the standard treatment went from 4.4 points to 2.4 points. The difference between the two groups was significant.

Gait also was substantially improved from baseline in the experimental treatment group, as shown by significant improvement in ankle and hip ranges of motion.

"The improved ankle range of motion is typically indicative that your foot is not painful, and you're returning to a more normal gait," he said. "The decrease in hip excursion indicates that patients weren't compensating as much when they walked, another sign of improved biomechanics due to reduced pain," said Dr. Desai, who also is director of the George Washington Pain Center in Washington.

Limited ankle dorsiflexion, secondary to a tiger gastronemius-soleus complex, is the most important risk factor for the development of plantar fasciitis, according to Dr. Desai. "Our hope is that instead of just treating the symptom, which is at the plantar fascia, we are also treating the tight medial and lateral gastrocnemius and soleus muscles and thereby correcting the underlying biomechanical problem."

He stressed that these results are preliminary and need to be confirmed in larger trials.

"Many patients, especially those whohave recalcitrant plantar fasciitis, get bounced around from podiatrists to surgeons to general practitioners. They get unsatisfactory answers or they end up having surgical treatments that are not effective," Dr. Desai said.

Dr. Desai disclosed no conflicts of interest. Funding for the study was provided by Allergan Inc., a producer of botulinum toxin type A.

BY FRAN LOWRY Orlando Bureau
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Title Annotation:Rheumatology
Author:Lowry, Fran
Publication:Internal Medicine News
Article Type:Clinical report
Geographic Code:1USA
Date:May 1, 2008
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