Abstract
Plantar fasciitis is a prevalent cause of heel pain in adults, particularly among the middle-aged population. It is characterized by microtrauma that exceeds the regenerative capacity of the plantar fascia. Although most cases respond well to conservative treatment, such as stretching exercises, orthotic use, and nonsteroidal anti-inflammatory drugs, some cases progress to chronic stages that require second-line therapies, including extracorporeal shockwave therapy, corticosteroid or platelet-rich plasma injections, or surgical plantar fascia release. This review aims to evaluate the efficacy of botulinum toxin type A (BTA) injections in the management of chronic plantar fasciitis. A narrative review was conducted without any date restrictions, covering the period from 1994 to 2025, through databases including PubMed, Scopus, ScienceDirect, and Google Scholar. Included studies focused on patients with plantar fasciitis unresponsive to conservative treatments, using pain and functional outcomes as endpoints. Three randomized controlled trials demonstrated that BTA injections significantly reduced pain and improved function across short, mid-, and long-term follow-ups. BTA acts at the neuromuscular junctions to reduce muscle tone and modulate pain pathways. BTA injections appear to be a safe and effective option for patients with chronic plantar fasciitis unresponsive to first-line therapies. Image-guided injections (ultrasound or electromyographic) are recommended to enhance accuracy. Further research is necessary to establish standardized protocols regarding the injection site, dosage, guidance technique, and reinjection timing.