Posted on our Newsletter as Article of the Month – March 2020 by David Burke, MD, MA 



Plantar fasciitis (PF) is a common cause of foot pain, which can at times be resistant to conservative treatment. Conservative management of PF includes orthotics, night splints, ice, stretching, injection with steroids and PRP.  In 2013, a novel surgical procedure was introduced involving the release of the medial head of the gastrocnemius, with improved PF symptoms.  This study assessed the efficacy of an injection of botulinum toxin A (BTA) at the head of the gastrocnemius as a non-surgical correlate of this procedure.

Subjects were 32 patients with chronic PF. The subjects were randomly assigned to receive injections into the proximal third of the medial head with either 50 international units of BTA or a similar volume of normal saline.  All injections were followed by six weeks of physiotherapy. The patients were assessed for pain using a 10-point visual analog scale (VAS) and for function with the American Orthopedic Foot and Ankle Society (AOFAS) Hindfoot Score, with assessments performed at baseline and up to 12 months following the injection.  

Pain scores improved in the BTA group from an average of eight at baseline to 0.33 at one year, while pain scores in the placebo group improved from 7.8 at baseline to four at one year (p<0.001).  Improved function at one year, as measured by the AOFAS, was also superior in the BTA group, as compared with the placebo group (p<0.001). This study adds to the nonsurgical options that Physiatrists have offer to their patients with recalcitrant PF.




Abbasian, M., et al. Outcomes of Ultrasound-Guided Gastrocnemius Injection with Botulinum Toxin for Chronic Plantar Fasciitis.  Foot Ankle Int. 2020, January; 41(1): 63-68.