The real risks of steroid injection for plantar fasciitis, with a review of conservative therapies

This article presents a review of conservative therapies for plantar fasciitis pain reduction with a discussion of steroid therapy risks. The therapies reviewed include orthoses, stretching, extracorporeal shockwave, BTX-A, and corticosteroid injection/iontophoresis. These modes were included based on the availability of double blinded randomized controlled trials. We noted the following findings. Orthoses, regardless of type, can improve pain levels. Plantar stretching shows limited short-term benefit (1 month), but can reflect significant long-term improvement (10 months). Extracorporeal shockwave therapy shows equivocal benefit with some studies showing significant improvement and others showing none. Although BTX-A injections were the least studied, significant pain improvement was demonstrated in the short and long term. Steroid injection/iontophoresis showed significant improvement in the short term (1 month). Steroid therapy, when coupled with plantar stretching, can provide efficacious pain relief; however, steroid injections should be combined with ultrasound monitoring to reduce complications.     

A型肉毒毒素对神经病理性疼痛大鼠镇痛作用及作用途径的研究

目的：观察A型肉毒毒素（BTX—A）对L5前根切断（L5 VRT）神经病理性疼痛模型大鼠的镇痛作用并探讨其最佳给药途径。方法：雄性SD大鼠108只,随机分为3组（n=36）,皮下注射给药组、坐骨神经表面给药组、坐骨神经注射给药组,制备L5 VRT模型,各组又分为术后4d给药组、术后8d给药组、术后16d给药组且同时各设0．9％氯化钠注射液对照组（n=6）,于术前、术后及术后不同给药时间测定50％撤足阈值（PWT）。结果：①皮下给药组能明显的改善机械痛敏,坐骨神经表面及坐骨神经注射给药组机械痛敏改善不明显。②皮下给药组术后各不同时间给药小组,均能明显的改善机械痛敏,与对照组相比有统计学意义（P〈0．05）;给药后第15天效果最明显;这种镇痛作用持续至少20余天。③坐骨神经表面及坐骨神经注射给药组动物的机械痛敏改善不明显,与对照组相比无统计学意义（P〉0．05）。结论：皮下注射BTX—A,能改善L5VRT模型大鼠的机械痛敏,有镇痛作用,且为最佳给药途径。     

A型肉毒毒素注射配合综合康复训练治疗痉挛型偏瘫型脑瘫患儿临床分析

目的探讨A型肉毒毒素治疗痉挛型偏瘫型脑瘫患儿的临床疗效。方法选择痉挛型偏瘫型脑瘫儿童40例,随机分为A型肉毒毒素治疗组20例和单纯康复治疗组（对照组）20例。治疗组将A型肉毒毒素注射到患儿腘伸肌群和小腿三头肌群,注射后第2天开始进行康复训练（共6个月）。所有患者治疗前及治疗后2周、1个月、3个月、6个月进行腘窝角和足背屈角角度的测量、改良的Ashworth量表、粗大运动功能分级量表进行评价。结果治疗组的腘伸肌群和小腿三头肌群肌张力和粗大运动功能评分均比注射前改善明显（P〈0.05）,治疗效果明显优于对照组（P〈0.01）。结论 A型肉毒素配合康复治疗可以有效降低患儿患侧的肌张力,有助于提高运动功能,缩短治疗时间。     

Local Injection of bortulinum toxin A at multiple points for decreasing the muscular tension of children with spastic cerebral palsy——A comparative observation

BACKGROUND: More than 70% children with cerebral palsy belong to the spastic one, and the increased muscular tension results in motor dysfunction and posture abnormality. OBJECTIVE: To observe the assistant effect of the local injection of BTX-A at multiple points in the rehabilitative treatment of spastic cerebral palsy. DESIGN: A comparative observation on the clinical efficacy. SETTINGS: Rehabilitation Center, Loufeng Hospital, Suzhou Industrial Park; Gansu Rehabilitation Center Hospital. PARTICIPANTS: Sixty-nine children with cerebral palsy were selected from the outpatients and inpatients who accepted rehabilitative treatments in the Cerebral Palsy Treatment Center of Gansu Rehabilitation Center Hospital from April 2003 and October 2004. Inclusive criteria: ① Having high risk factors for brain injury before birth and within 1 month after birth, mainly manifested as central motor disorder and posture abnormality; ② Accompanied by increase of muscular tension in both lower limbs, appearing as tiptoes and scissors gaits while in standing position or walking; ③ Without fixed contracture of lower limb; ④ Had never been operated for lower limbs; ⑤ Had never been injected with BTX-A; ⑥ Clearly diagnosed to have spastic palsy. The enrolled children were not screened by disease conditions, course, age, etc., and informed consents were obtained from the parents of all the children. The children whose parents agreed to accept BTX-A treatment were taken as BTX-A treated group (n =45), and the others as control group (n = 24). METHODS: All the children accepted regular rehabilitative training after admission, 6 times a weeks, besides, those in the BTX-A treated group were given local injection of BTX-A at multiple points of target muscles, including bilateral adductor longus muscles, pectineal muscles, gastrocnemius muscles and soleus muscles. BTX-A was diluted with saline (5 U BTX-A in 0.1 mL), 3–4 U/kg for each piece of muscle. The number of injected sites depended on the size of target muscle, and no more than 0.5 mL for each site. The injection should be followed by manual massage for 1–2 minutes, and electromuscular stimulation for 20 minutes, which were continued for 3 days. They participated in the comprehensive rehabilitative training and treatment at 24 hours after injection. MAIN OUTCOME MEASURES: The comprehensive abilities of cerebral palsy were evaluated, the adductor angle and forced area on soles were measured before treatment and at 3 and 6 months after treatment. RESULTS: All the 69 children with spastic cerebral palsy were involved in the analysis of results. ① Efficacy in the BTX-A treated group: BTX-A began to take effect at 48 hours after injection, and the maximal effect was observed in all the cases on the 6th day; 2 weeks later, the scissors gaits and hip adduction were obviously improved in 39 and 11 cases, respectively, and tiptoes gaits were improved in 22 cases; 2 months later, tiptoes gaits were improved in 43 cases. ② Efficacy in the control group: Two months later, certain improvements of scissors gaits were observed in 2 children with mild cerebral palsy; the scissors gaits and tiptoes were obviously improved in 6 cases of moderate cerebral palsy and 3 cases of mild one after 3 months, and there were changes of the parameters after 6 months in 1, 10 and 5 cases of severe, moderate and mild cerebral palsy, respectively. ③ Improvement of adductor angle before and after treatment in both groups: The muscular tension was evaluated according to Komam's method. There was no obvious difference in the adductor angle between the two groups before treatment (P > 0.05). The adductor angle had very significant difference (P < 0.01) and significant difference (P < 0.05) between the two groups at 3 and 6 months after treatment. ④ Changes of forced area on soles before and after treatment in both groups: The forced area on soles was assessed referred to the method of foot-print analysis. There was no obvious difference in the forced area on soles between the two groups before treatment (P > 0.05). The forced area on soles had very significant difference (P < 0.01) and significant difference (P < 0.05) between the two groups at 3 and 6 months after treatment. CONCLUSION: BTX-A local injection is an important assistant therapeutic method for treating spastic cerebral palsy. For the patients with moderate and severe cerebral palsy, BTX-A local injection should be combined with rehabilitative training to obviously shorten the course and improve efficacy.     

A型肉毒毒素注射治疗腋窝多汗症或伴腋臭症

目的 探讨A型肉毒毒素(botulinum toxin-A,BTX-A)注射治疗腋窝多汗症或伴腋臭症及单纯液臭的疗效.方法 采用BTX-A每侧腋窝注射50 U治疗,注射选点25个,间距1.5 cm,每点注射2.5 U.结果 共治疗特发性局限性腋窝多汗症或伴腋臭患者42例,其中单纯腋窝多汗症24例全部有效.腋窝多汗症伴有腋臭10例,其中注射后多汗症治疗全部有效,腋臭治疗有效者只有1例.单纯腋臭8例,碘淀粉试验阴性,注射后只有1例显效,无效7例.结论 BTX-A治疗腋窝多汗症有效,副作用轻微、一过性.BTX-A治疗多汗症所伴有的腋臭疗效欠佳,对单纯的腋臭治疗基本无效.     

肉毒毒素结合肌力训练治疗痉挛型双瘫患儿39例疗效观察

目的:探讨A型肉毒毒素(BTX-A)注射结合肌力训练对痉挛型双瘫患儿粗大运动功能的影响。方法:将72例痉挛型双瘫患儿依据其意愿分为观察组39例和对照组33例,均进行综合康复训练,且观察组在此基础上加用BTX-A注射和肌力训练。治疗前和治疗3个月后分别采用改良Ashworth量表(MAS)和粗大运动功能测试量表(GMFM)中站立相(D)和走、跑、攀登相(E)二项进行疗效评估。结果:治疗前后两组MAS评分和GMFM中D项、E项评分比较差异均有统计学意义(P<0.01),且治疗后两组比较差异均有统计学意义(P<0.05)。结论:BTX-A注射结合肌力训练能快速有效地缓解痉挛型双瘫患儿下肢肌肉的痉挛,提高患儿粗大运动功能。     

A型肉毒毒素注射治疗腋窝多汗症或伴腋臭症

目的 探讨A型肉毒毒素(botulinum toxin-A,BTX-A)注射治疗腋窝多汗症或伴腋臭症及单纯液臭的疗效.方法 采用BTX-A每侧腋窝注射50 U治疗,注射选点25个,间距1.5 cm,每点注射2.5 U.结果 共治疗特发性局限性腋窝多汗症或伴腋臭患者42例,其中单纯腋窝多汗症24例全部有效.腋窝多汗症伴有腋臭10例,其中注射后多汗症治疗全部有效,腋臭治疗有效者只有1例.单纯腋臭8例,碘淀粉试验阴性,注射后只有1例显效,无效7例.结论 BTX-A治疗腋窝多汗症有效,副作用轻微、一过性.BTX-A治疗多汗症所伴有的腋臭疗效欠佳,对单纯的腋臭治疗基本无效.     

Management of the ageing eyebrow and forehead: an objective dose–response study with botulinum toxin

OBJECTIVE: To determine if clinical use of two different doses of botulinum exotoxin A (BTX-A) injections to the forehead area result in wrinkle reduction and modifications of eyebrow position. DESIGN: Prospective study. SETTING: Private practice, Dermatologic Laser Centre, Marseille, France. SUBJECTS: Twenty-four adult patients treated with BTX-A (Vistabel) injections for forehead rhytides. INTERVENTION: Of the 24 patients, 12 received BTX-A injections of 5 U only and 12 received injections of 10 U into the forehead, with or without treatment of the lateral forehead. The eyebrow position, forehead height and number of forehead lines determine the number of injection points. Patients were evaluated before injection and every 2 months after treatment during next 8 months. RESULTS: In the two groups of 12 patients, we found no significant change between the two doses. At each time after injections (every 2 months until 8 months), both groups showed a statistically significant improvement except at 8 months. Both groups exhibited the same results on standardized photos and on 3D skin profilometry. CONCLUSIONS: The two doses of BTX-A injections into the forehead gave the same results. The duration of the effect is similar along 8 months. This study emphasizes the role of low doses of BTX-A injections to obtain good clinical results without freezing aspect.     

A型肉毒毒素深部肌肉注射治疗脑外伤后肢体肌痉挛

目的探讨A型肉毒毒素(BTX-A)治疗脑外伤后四肢肌痉挛的注射方法及疗效。方法选取32例2004年1月至2007年2月在我院神经外科及康复科治疗的脑外伤后肢体肌肉痉挛病人,每例行国产A型肉毒毒素痉挛肌等距离多点均匀深部注射治疗,每次注射总量不超过100U,每次注射1-2块肌肉。若肌肉较大或多块肌肉痉挛,可分次注射,每次间隔至少7天,同时辅以常规肢体功能锻炼.注射后3天、7天、14天、1月、2月、3月、6月采用改良Ashworth量表测定肌张力改变,每例病人随访6月。结果32例治疗病人均在注射BTX-A后第3-7天内肌张力下降,在2-8周时达到明显效果(P<0.05),3月后有4例出现不同程度复发,6月后25例复发,痉挛程度较注射前轻,重复注射BTX-A后可缓解。BTX-A注射后有4例出现局部轻度淤血,未发现明显全身并发症。结论等距离深部肌注A型肉毒毒素治疗脑外伤后四肢肌痉挛安全有效,操作简单,并发症少,为康复治疗赢得时间,值得在临床推广。     

肌构筑学原理在A型肉毒毒素治疗脑卒中后痉挛中的应用

目的观察肌构筑学原理在A型肉毒毒素治疗脑卒中后痉挛中的应用。方法40例脑卒中后偏瘫患者,伴有上肢屈肌、下肢伸肌痉挛,改良Ashworth评分3级以上,分为观察组和对照组各20例,进行屈腕肌和小腿三头肌A型肉毒毒素注射,观察组应用肌构筑学原理对肌群之间的药物剂量进行分配和注射点数确定,对照组是依照常规注射参考剂量和注射点数。均以神经刺激器辅助定位进行注射,并注射后2周对比两组改良Ashworth评分及支具穿戴情况。结果肉毒毒素注射后改良Ashworth评分:上肢掌屈肌观察组为(1.3±0.9234),对照组为(1.9±0.8522);下肢小腿三头肌观察组为(1.6±0.8826),对照组为(2.25±0.7864),均有显著性差异(P<0.05)。治疗后,上肢不用支具观察组为10例,对照组为6例;下肢不用支具观查组为8例,对照组为4例,均无显著性差异(P>0.05)。结论应用肌构筑学原理确定各肌群的A型肉毒毒素剂量和注射点数较以常规注射方法能更有效缓解肌张力,但对支具的穿戴影响不明显。