Therapeutic efficacy and safety of botulinum toxin A injection in plantar fasciitis: A systematic review and meta-analysis

Objective: The purpose of this meta-analysis was to evaluate the therapeutic efficacy and safety of botulinum toxin A (BTA) injections for treatment of plantar fasciitis (PF). Methods: This review adhered to the PRISMA guidelines, conducting a comprehensive search of the PubMed, Web of Science, EMBASE, and Cochrane Library databases for eligible studies from their inception to December 30 2023. The inclusion criteria were limited to randomized controlled trials (RCTs) comparing BTA injections with control interventions in terms of pain reduction, functional improvement, or the occurrence of adverse events in treating patients with PF were extracted for meta-analysis. Relevant data were extracted using an electronic spreadsheet and analyzed with Stata 16.0 software. The quality of included studies was assessed using the Cochrane Collaboration’s tool. Results: A total of 655 studies were retrieved and subsequently screened. Seven RCTs, comprising 305 participants, met the eligibility criteria and were included in the meta-analysis. The pooled results indicated that BTA injections led to significant pain reduction only at 1-month posttreatment (SMD = -1.72, 95% CI [-3.10, -0.34], p = 0.01]) and sustained functional improvement over twelve months (SMD = 25.10, 95% CI [9.67, 40.53], p = 0.001) compared to the control group. There was no significant difference in the occurrence of adverse events between the BTA and control interventions (OR = 0.16, 95% CI [-1.00, 1.32], p = 0.79). Conclusion: This meta-analysis suggested that BTA injection could be an effective and safe therapeutic strategy for plantar fasciitis. However, further larger-scale, rigorously designed RCTs are needed to validate these findings and determine the optimal injection dosage and site for BTA in the treatment of plantar fasciitis.