Should I Try Botox for Plantar Fasciitis?

If you clicked on this headline, it’s because you’re either looking for a cure for plantar fasciitis or because you just can’t believe Botox—the popular cosmetic injection for wrinkles—has made its way into sports medicine. But it’s true, Botox for plantar fasciitis is a thing, and for some endurance athletes, it’s a thing that works incredibly well.

Plantar fasciitis is one of the most common complaints of runners, accounting for almost 10% of all running-related injuries. It occurs as a result of inflammation in the plantar fascia, a ligament located along the underside of the foot. The tell-tale sign of plantar fasciitis is a sharp pain in the bottom of the foot. For some, the pain can be so debilitating that walking, much less running, feels impossible. Those who have experienced plantar fasciitis know how challenging it can be to find a fix. Typically, rest is the best cure for plantar fasciitis, but that’s frustrating advice for someone who has a race on the calendar and doesn’t want to fall behind in training. Stretching, massage, and miracle fixes, like night splints or orthotics, don’t always work.

In cases of persistent and/or severe plantar fasciitis, Botox may be an option, said podiatrist Dr. Wenjay Sung.

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How does Botox work as a treatment for plantar fasciitis?

Botox is a prescription medicine made from a purified form of botulinum toxin. Although this is the same toxin that causes botulism (a life-threatening form of food poisoning) its effects vary according to the amount and type of exposure. In small doses, it temporarily weakens and/or paralyzes muscles. It’s most commonly used in cosmetic applications to prevent dynamic wrinkles, which develop when the skin is repeatedly creased while smiling, laughing, and frowning. But that’s not the only use for Botox, said Sung.

“Botulinum toxin has been found to have anti-nociceptive and anti-allodynia effects,” explains Sung. “This modulates pain neurotransmitters including Substance P, glutamate, and anti-inflammatory reactions.” In other words, Botox blocks the sensory neurons from feeling pain.

When Botox is injected into the affected foot, it paralyzes the small muscles surrounding the plantar fascia. This deactivates the above-mentioned neurotransmitters, whose job is to tell the brain that it’s feeling pain. It also has an anti-inflammatory effect on the fascia, which can further minimize pain and expedite the healing process.

Does it actually work?

Multiple studies have found Botox to be more effective than a placebo or steroids for treatment of plantar fasciitis. A 2017 study treated 50 plantar fasciitis patients with either a placebo saline solution or Botox injections and analyzed their symptoms, and found that Botox injections reduced plantar fasciitis pain and improved foot function. A 2019 study agreed, stating that Botox could be a better alternative to steroids and surgery for treating plantar fasciitis.

Can I get Botox for my plantar fasciitis?

Botox isn’t a first-line treatment for plantar fasciitis. “This is a treatment for those with chronic heel pain who have failed previously conservative care,” Sung said. “We usually reserve it as an advanced modality for those who have failed steroid injections, physical therapy, icing, heating, stretching, and orthotics after three or four months of treatment.”

Though you typically can try to treat plantar fasciitis yourself, it’s not recommended. If you’re a runner or triathlete with heel pain that won’t go away, it’s always a good idea to check in with a podiatrist, physical therapist, or sports medicine doctor first. These experts can teach you stretches and home remedies for plantar fasciitis and ensure you’re doing them correctly, so you don’t waste time or money in your quest for relief. If you do get to the point where Botox is needed, you will have documentation that you have, in fact, tried everything else first.

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How long does it take for Botox to work? How long does it last?

After your injection for plantar fasciitis, you might see relief as soon as 24 hour, though it can take up to two weeks for full effect. Results can last up to four months, at which point the injection can be repeated if needed.

Side effects of using Botox for plantar fasciitis

All medications have side effects, and Botox is no exception. Some people experience swelling, redness, or tenderness around the injection site, but this is mild and temporary. Though more severe side effects are rare, they do sometimes occur.

“One possible side effect is fat pad atrophy, where the fat pad of the heel is reduced,” Sung said. “This can cause stress fractures or even more pain to the heel.”

Another possible side effect is nerve damage, as Botox reacts directly on nerve endings. Again, this is rare, especially when used for plantar fasciitis, as opposed to cosmetic procedures. “Nerve damage is usually temporary and most patients do not experience severe nerve damage with Botox,” Sung said.

How to get Botox for plantar fasciitis

If someone claims to be a “certified” Botox injectionist for plantar fasciitis, beware. There is no certification process for Botox injections into the foot, as it is considered off-label use of the drug. “It is the same with Botox treatment for wrinkles, as this is also considered off-label,” Sung said. Instead, Sung recommends consulting with a board-certified podiatrist who specializes in heel pain. The American Podiatric Medical Association has a search engine for these doctors, as does the American College of Foot and Ankle Surgeons.