Could Botulinum Toxin Injections Impact Hammertoe Pain and Pressure?

Could the paralytic effects of Botox lead to a therapeutic effect for digital contractures? A poster presented at the American Society of Podiatric Surgeons Annual Conference aims to assess that potentiality. In their case study, the authors looked at 2 subjects, with follow-up at 3, 6, and 18 months. Each patient underwent a single ultrasound-guided injection in the extensor digitorum brevis muscle belly with 50 units of Botulinum Toxin Type A suspended in 1.5 mL of 0.9% sterile saline and optional lidocaine plain 1%. Subjects reported visual analog pain scales, and plantar pressures were measured before treatment and 4 months post-injection.
 
Based on their findings, the authors surmise that the paralytic effects of the Botulinum toxin could lead to reduction of soft tissue contracture at the MTPJ, thus reducing retrograde plantar forces and plantar pressures. This reduction could reduce potential ulceration risk, especially for patients who are not candidates for surgical intervention. The authors noted that this treatment option may provide temporary relief and reduce risk of progression, but does not address the underlying etiology of the deformity. They also acknowledge that a larger sample size is needed to confirm their findings and note that such a pilot study is being explored.
 
Khurram H. Khan, DPM, FACFAS, FACPM, a co-author on the poster, says he and his group felt this treatment modality was an interesting way to reduce pain in this patient population. 
 
“Hopefully in future studies we will continue to see both a decrease in pain as well as pressure from the hammertoes, specifically the second toe, and we look forward to starting our IRB study soon,” says Dr. Khan.
 
Dr. Khan encourages podiatrists to think outside of the box for patients where surgery is not an option, and acknowledges the need for therapeutic alternatives. He stresses the importance of supporting research done at podiatric medical schools and residencies in order to promote unbiased, academically focused literature.