Residual Limb Hyperhidrosis Managed by Botulinum Toxin Injections, Enhanced by the Iodine-Starch Test: A Case Report

PM R. 2017 Apr;9(4):415-418. doi: 10.1016/j.pmrj.2016.10.009. Epub 2016 Oct 22.


Hyperhidrosis of the residual limb is a common condition affecting patients with amputations. The iodine-starch test is used by dermatologists to identify focal areas of hyperhidrosis before treatment with botulinum toxin. Here, we describe a case of a patient with a transtibial amputation with moderate-to-severe hyperhidrosis who received intradermal botulinum toxin injections to treat residual limb hyperhidrosis, with particular emphasis given to the utility of the iodine-starch test in managing this common condition. The iodine-starch test successfully identified hyperhidrotic areas before treatment as well as confirmed the physiologic anhidrotic effect of the botulinum toxin treatment.

Level of evidence: V.

Publication types

  • Case Reports

MeSH terms

  • Amputation Stumps / physiopathology*
  • Amputation, Surgical / adverse effects*
  • Amputation, Surgical / methods
  • Amputation, Traumatic / surgery*
  • Botulinum Toxins, Type A / administration & dosage*
  • Diagnostic Tests, Routine
  • Follow-Up Studies
  • Humans
  • Hyperhidrosis / diagnosis
  • Hyperhidrosis / drug therapy*
  • Hyperhidrosis / etiology
  • Injections, Intradermal
  • Male
  • Risk Assessment
  • Starch / analogs & derivatives
  • Tibia / surgery
  • Treatment Outcome
  • Young Adult


  • iodinated starch
  • Starch
  • Botulinum Toxins, Type A