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Botox beats steroids for painful foot condition, plantar fasciitis

Plantar fasciitis is the most frequent cause of chronic heel pain, leaving many sufferers unable to put their best foot forward for months at a time. Now a Mexican study suggests that physicians should turn to Botox rather than steroids to offer patients the fastest road to recovery. The research appears in the journal Foot & Ankle International, published by SAGE.
Plantar fasciitis results when connective tissues on the sole of the foot, the plantar fascia, become painfully inflamed. Physicians may suggest various therapies for this condition, including applying steroids, regular stretching exercises or injecting botulinum toxin A (BTX-A), also known as Botox.

Steroid treatment is often used to treat plantar fasciitis, but it can cause complications. In an estimated 2-6 percent of patients, steroid treatment leads to the plantar fascia rupturing. Researchers from the Autonomous University of Nuevo Leon, Mexico devised a trial to compare steroid treatment with the botulinium toxin alternative, which works by blocking the neurotransmitter acetylcholine, weakening the muscles for several months.

The researchers set up a prospective, experimental, randomized, double-blinded, and controlled clinical trial, where patients were treated either with steroids or with Botox for their painful feet. Both groups were shown the same series of physical exercises to help their recovery.

Initially the two patient groups appeared to be recovering at a similar rate. However, the Botox group then took the lead in scores relating to foot pain, function and alignment. After six months, patients who received Botox injections were the clear winners, demonstrating more rapid and sustained improvement than their counterparts on the steroid regime.

"We found that a combination of BTX-A applications into the gastroc-soleus complex and plantar fascia stretching exercises yielded better results for the treatment of plantar fasciitis than intralesional steroids," says the study's corresponding author, Dr. Carlos Acosta-Olivo, adding that the plantar fascia stretching exercises were an important component of successful treatment.

A number of factors contribute towards the likelihood of developing plantar fasciitis, including tight hamstring muscles, or being overweight. The authors suggest incorporating measures of body mass index (BMI) into future studies. This was a relatively small-scale study, with just 36 patients completing the trial. However the results do indicate that given the risk of complications with steroids, Botox along with stretching exercises, could be the treatment of choice for this painful condition.

"A Comparison of Botulinum Toxin A and Intralesional Steroids for the Treatment of Plantar Fasciitis: A Randomized, Double-Blinded Study" by Jorge Elizondo-Rodriguez, Yariel Araujo-Lopez, J. Alberto Moreno-Gonzalez, Eloy Cardenas-Estrada, Oscar Mendoza-Lemus, and Carlos Acosta-Olivo published January 2013 in Foot & Ankle International. To read the full text of the article, free for a limited time, click here:
The AOFAS promotes quality, ethical and cost-effective patient care through education, research and training of orthopaedic surgeons and other health care providers. It creates public awareness for the prevention and treatment of foot and ankle disorders, provides leadership, and serves as a resource for government, industry and the national and international health care community.

Orthopaedic foot and ankle surgeons are medical doctors (MD and DO) who specialize in the diagnosis, care, and treatment of patients with disorders of the musculoskeletal system of the foot and ankle. This includes the bones, joints, ligaments, muscles, tendons, nerves and skin. Orthopaedic foot and ankle surgeons use medical, physical, and rehabilitative methods as well as surgery to treat patients of all ages. They perform reconstructive procedures, treat sports injuries, and manage and treat trauma of the foot and ankle.

Orthopaedic foot and ankle surgeons work with physicians of many other specialties, including internal medicine, pediatrics, vascular surgery, endocrinology, radiology, anesthesiology, and others. Medical school curriculum and post-graduate training proves the solid clinical background necessary to recognize medical problems, admit patients to a hospital when necessary, and contribute significantly to the coordination of care appropriate to each patient. S

AGE is a leading international publisher of journals, books, and electronic media for academic, educational, and professional markets. Since 1965, SAGE has helped inform and educate a global community of scholars, practitioners, researchers, and students spanning a wide range of subject areas including business, humanities, social sciences, and science, technology, and medicine. An independent company, SAGE has principal offices in Los Angeles, London, New Delhi, Singapore and Washington DC.

Camille Gamboa | EurekAlert!
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