A Comparison of the Effect of Botulinum Toxin Type a and Corticosteroid Injections in Chronic Planter Fasciitis

Background: Plantar fasciitis is a common musculoskeletal disease. It showed mainly chronic degenerative processes rather than inflammation. Injections of corticosteroids are a popular treatment for plantar fasciitis because they reduce inflammation and pain. Another approach has recently been proposed for the management of plantar fasciitis: injection with botulinum toxin type A. Aim of study: To compare between the effect of steroid and botulinum toxin type A injection for planter fasciitis. Patient and Methods: An interventional clinical trial that was conducted in Ghazi Al-Hariri Hospital and Baghdad pain clinic, Baghdad, Iraq during a period of one year from April 2024 to April 2025. It included 40 patients who complained about heel pain at the origin of the plantar fascia (anteromedial calcaneal tuberosity) and diagnosed with plantar fasciitis. They were divided into two groups: Steroid group included 20 patients received a single application of 1 ml methylprednisolone 40 mg (depomedrol) with local anesthetic 2 ml of lidocaine 1% and 2 ml of normal saline (Total volume of 5 ml) and Botox group included 20 patients received a single application 50 U of BoNT-A in a total volume of 2 ml. Numerical rating scale of pain and planter fascia thickness by ultrasound were evaluated at one week, three weeks and two months after injection. Results: In this study, the level of pain was significantly decreased in both groups after one week, three weeks, and two months compared to that at baseline. One week after intervention, the mean level of pain was significantly higher in the steroid group than that in Botox group. Thickness of plantar fascia was significantly decreased in both groups after three weeks and two months compared to that at baseline. Conclusion: Both steroid and Botox injections can significantly relieve pain and thickness associated with plantar fasciitis, but the early comparative advantage of Botox in pain relief may warrant further exploration in larger studies to verify sustained benefits.