# Insertional Achilles Tendinopathy Treated With Botulinum Toxin: A Case Report

## TL;DR

A patient with chronic heel pain from Achilles tendinopathy was treated with botulinum toxin injections, showing potential for this treatment in a condition that is often hard to treat.

## Contribution

This is the first reported case of using botulinum toxin A for treating insertional Achilles tendinopathy.

## Key findings

- Botulinum toxin A was used in an ultrasound-guided injection for recalcitrant insertional Achilles tendinopathy.
- There have been no prior published studies on the efficacy of botulinum toxin A for Achilles tendinopathy.
- The case suggests potential for botulinum toxin A as a treatment option when conservative methods fail.

## Abstract

Chronic insertional Achilles tendinopathy (IAT) is a common cause of recalcitrant heel pain. Patients present with pain localized to the Achilles tendon insertion at the calcaneus and have tenderness to palpation in this area on physical exam. Conservative management often includes an exercise prescription focusing on eccentric loading with limited dorsiflexion. Extracorporeal shockwave therapy and injection therapies including hypertonic dextrose and platelet-rich plasma (PRP) have shown some therapeutic benefit but evidence for injections is limited. IAT can often be recalcitrant to non-operative treatments, and cases are often referred for surgical debridement and decompression. Botulinum toxin A (BTX-A) has been used to treat several different musculoskeletal injuries, but there have been no published studies assessing the efficacy of BTX-A injections specifically for Achilles tendinopathy. This is a case of recalcitrant IAT treated with ultrasound-guided BTX-A.