The Surprising Plantar Fasciitis Treatment You Probably Haven’t Heard About

Runners World
By Robert Annis February 19, 2019

Last fall, I got to chatting with Peter McAllister, M.D., neurologist and Chief Medical Officer of the New England Institute for Clinical Research, when the talk turned to toxins—botulism toxin, to be exact, or better known as Botox.

Commonly thought of as a way for the Real Housewives of Anywhere to claw back the hands of time, Botox is actually FDA-approved for a variety of other, more serious medical maladies, including limb spasticity after stroke, overactive muscle disorders, excessive sweating, and chronic migraines. For the last several years, McAllister, one of the world’s leading authorities on Botox’s therapeutic uses, has been using it to treat one of runners’ most common complaints, plantar fasciitis.

Just as Botox is used to temporarily smooth out wrinkles (injected underneath the skin, it paralyzes the muscles allowing them to relax), it can also relieve the pain and pressure on the inflamed ligament that runs underneath your foot. McAllister says he’s treated about 150 plantar fasciitis patients with promising results.

What is Plantar Fasciitis?

Plantar fasciitis is one of the most common runner injuries, typically afflicting about 10 percent of athletes. It occurs when the plantar fascia, the supportive ligament connected to the heel that stretchs along the underside of the foot, and the surrounding sensory nerves becomes inflamed through increases in mileage, poor foot structure, and/or inappropriate running shoes. Pain is typically worse in the mornings when getting out of bed, easing throughout the day as the ligament stretches.

The longer the plantar fasciitis goes untreated, the more the ligament becomes used to the stress and acute inflammation decreases. That might sound good, but the tiny tears throughout the nerve means the pain becomes chronic.

Standard treatments include orthotics, daily stretching, and cortisone injections, among others, but doctors are becoming more reluctant to use cortisone, as it can dissolve the foot’s fat pad, making the issue worse in the long run.

For the past eight years, Florida podiatrist and podiatric surgeon Adam D. Perler, D.P.M., has extensively used amniotic tissue to treat plantar fasciitis. Harvested from umbilical cord and afterbirth material, the amniotic tissue is injected into the damaged area, jumpstarting the body’s own healing process. Because the treatment relies on temporary inflammation, patients may actually feel worse before as the injury heals, at least for a few weeks. But with Botox, there’s typically no pain involved. After reading the studies, Perler has been intrigued by the possibilities, and says he may begin using the treatment in his practice, especially in patients who may have an overlying nerve problem in addition to the typical plantar fasciitis.

How Botox Works

Botox is made from a highly diluted botulism toxin, that blocks key neurotransmitters where injected. The drug helps relax the tissues in and around the plantar fascia, but does not retard the healing process like cortisone, so it’s possible that over time, in conjunction with stretching exercises, the patient will heal on their own. According to McAllister, many cases are resolved after just one treatment while other, more severe cases may require injections every three months.

What the Science Says

Multiple published medical studies have found that Botox injections worked significantly better than either placebos or steroids. One small-scale study found that after six months, patients treated with Botox healed quicker and stayed healthier longer than patients treated with steroids. There are also fewer complications than injecting steroids, which actually ruptured the plantar fascia in up to 6 percent of patients.

How to Tell If It’s Right for You

If standard care—physical therapy, orthotics, non-steroid treatments—haven’t worked, McAllister suggests giving Botox a try. Most standard treatments take about six weeks to help, but McAllister says most of his patients are able to resume workouts between three and seven days after the injections.

Botox hasn’t been approved by the Federal Drug Administration for plantar fasciitis treatment yet, which means many insurance plans might be reluctant to cover the cost, which could reach $500 per treatment, and you may have a harder time finding a doc who will use it or has experience using it. But for the millions of runners, hikers, and other outdoor athletes who suffer from the pain, it might be worth the cost and the hassle. (Biomedical firm Revance is working on gaining FDA approval for their yet-unnamed Botox competitor, but spokeswoman Mariann Caprino said “there’s a ways to go” before that happens.)

If Botox is approved by the FDA for plantar fasciitis, Perler sees it being used as a potential treatment for several other running woes, including Achilles tendonitis, plantar fibromatosis, and chronic exertional compartment syndrome.

On the downside, Botox’s potential side effects include muscle stiffness, neck or back pain, itching, among others, but those are exceptionally rare when used to treat plantar fasciitis; McAllister says the injection stays in the area of the body where it’s inserted.

On the upside, your foot might have fewer wrinkles after treatment.