Botulinum toxin type A (BTX-A) has been shown to be a safe and effective treatment for focal or segmental muscle overactivity, including spasticity. Local injections of BTX-A are particularly valuable in relieving focal spasticity around a joint or a series of joints. When integrated into an overall spasticity treatment plan with clearly outlined functional goals, BTX-A may offer significant benefits to the appropriately selected adult or pediatric patient. A range of clinical outcome measures are used to evaluate the patient prior to injection. Initial dosing guidelines are offered, though each patient may have a unique drug response profile and set of modifying factors that will be used as a basis for dose adjustments. Clinical benefit usually lasts for approximately 12 weeks, though in some patients the duration of effect may be longer. Assessment of the patient's clinical and functional status is performed at each follow-up appointment, and the contribution of BTX therapy to the goals of the patient and caregiver are evaluated. Other therapeutic options should be considered where appropriate, and the treatment plan revised when necessary. Guidelines for dilution, handling, and office procedure are offered.