Plantar fasciitis (PF) is a common cause of chronic foot and heel pain in active and sedentary adults. It is present in approximately 0.85% of the population and is more common in the obese, women, and those aged 45?64 years. Point tenderness at the inferior calcaneus, radiation of pain to plantar fascia on dorsiflexion of ankle and extension of toes, and thickening of the plantar fascia on imaging are strong diagnostic indications of PF. Most cases of PF can be managed with conservative therapy, including weight loss, stretching, and foot strengthening, and NSAIDs LCI, PRP, and botulinum toxin-A injections at the plantar fascia are all effective in relief of symptoms and return of functionality in the foot. Treatments such as radiofrequency ablation of local nerves and ESWT are even superior to local injections and are effective in many patients refractory to all other treatment.

Plantar fasciitis (PF) is the most common cause of chronic heel pain, predominantly impacting those who perform heavy footwork, are avid runners or lare ong-distance walkers. Overuse injury leads to repetitive microtears of the plantar fascia near the calcaneus, irritating pain fibers and producing secondary inflammation. Patients typically have intense heel pain, described as aching, jabbing or burning. Pain usually starts with the first few steps in the morning and is reproduced by palpation of the median tubercle of the calcaneum and with dorsiflexion of the toes.

Conventional treatments such as ice, heel cup orthoses, deep-tissue massage and night splints, periods of immobilization and stretching/strengthening exercise programs can reduce pain satisfactorily. Persistent discomfort may respond to treatments such as ultrasound, iontophoresis and phonophoresis. More severe and recalcitrant cases require extracorporeal shock wave therapy (ECSWT) or local corticosteroid injections. When medical approaches fail, surgery is advocated but can only offer modest results.

This chapter reviews pertinent studies to date on the application of botulinum neurotoxin to plantar fasciitis, and discusses injection technique and dosing, including the WRAMC–Yale technique for injecting the soleus muscle, along with the plantar fascia. Clear anatomical illustrations are provided.