Clinical Efficacy of Botulinum Toxin in the Treatment of Plantar Fasciitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Arch Phys Med Rehabil. 2022 Feb;103(2):364-371.e2. doi: 10.1016/j.apmr.2021.10.003. Epub 2021 Oct 22.


Objective: To evaluate the efficacy of botulinum toxin A (BTX-A) for the treatment of plantar fasciitis through a meta-analysis of randomized controlled trials (RCTs) focusing on pain and functional outcomes since current literature has supported a potential benefit of BTX-A.

Data sources: The MEDLINE, EMBASE, Web of Science, and Scopus databases were searched until December 2020 for RCTs reporting the effects of BTX-A injections on plantar fasciitis. The complementary literature search included Cochrane Central Register of Controlled Trials,, and

Study selection: Only RCTs assessing the effect of BTX-A injections on pain, functional improvement, or plantar fascia thickness in patients with plantar fasciitis were included. Multiple researchers carried out the screening process of the 413 records.

Data extraction: Data were extracted independently and in duplicate using a standardized data extraction format. Information was contrasted by a third observer.

Data synthesis: BTX-A injections resulted in significant pain relief (mean difference, -2.07 [95% CI, -3.21 to -0.93]; P=.0004; I2=97%) and functional improvement (standardized mean difference, 1.15 [95% CI, 0.39-1.91]; P=.003; I2=87%). A subanalysis indicated that pain relief was sustained at 12 months while functional improvement remained significant after 0-6 months. The results were not affected by a single study after sensitivity analysis. The site of injection and the use or not of ultrasound-guided injections may account for potential sources of interstudy heterogeneity.

Conclusions: This meta-analysis suggests both a statistically significant and a clinically meaningful improvement on plantar fasciitis symptoms after BTX-A treatment.

Keywords: Botulinum toxins, type A; Fasciitis, plantar; Meta-analysis; Pain; Rehabilitation; Systematic review.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Botulinum Toxins, Type A* / therapeutic use
  • Fasciitis, Plantar* / drug therapy
  • Humans
  • Pain / drug therapy
  • Randomized Controlled Trials as Topic
  • Treatment Outcome


  • Botulinum Toxins, Type A