Botox: Stepping in a New Direction

Everyone has heard of Botox being used to reduce the appearance of fine lines and wrinkles, but now the muscle-immobilizing treatment is moving to the opposite end of the body and providing remarkable benefits that are getting patients back on their feet.

Two doctors at the Center for Orthopaedics, Craig Morton, MD, physical medicine and rehabilitation specialist, and Tyson Green, DPM, foot and ankle specialist, have teamed up to use Botox in a new way for patients with certain medical conditions of the feet.

Dr. Green says diabetic patients with foot ulcers are one group who may benefit tremendously from Botox treatment.

It is estimated that 17 million people in United States have diabetes, and about 15% of them will develop a foot ulcer at some point in their lives. "Because of the circulatory problems often present in these patients, these ulcers can be very difficult to treat successfully, and often develop into non-healing wounds with serious complications," says Dr. Green. In fact, each year, foot ulcers lead to more than 82,000 amputations, a devastating complication of diabetes.

Dr. Green explains that in many cases the most effective way of treating diabetic foot ulcers is to apply casting on the foot. This removes the pressure off the foot and helps the ulcers to heal. However, foot ulcers often return once the casting is removed and the patient starts walking with shoes on again. "Healing the ulcers is tough, but keeping them healed is tougher," he states.  "At this stage, the skin on the foot is not strong enough to handle the pressure during walking, and the same pressure points are at risk of ulcerating again.  That's where Botox helps.  Botox relaxes the tension on the foot, giving it a more stable position.  Then the wound can heal and it will have adequate offloading, so that you're not having added pressure on the wound site."

Dr. Morton injects the Botox into specific locations in the calf and the feet to loosen the muscles in the area, which provides the pressure point relief.  The muscles recover from Botox in two-three months, giving the wound time to fully heal.

He says the same mechanism is also providing tremendous benefits to patient with muscle spasticity.  "If there's damage to the brain or spinal cord, such as what you'd see in a traumatic spinal cord injury, head injury, stroke, multiple sclerosis, or cerebral palsy, for example, it can result in abnormal posturing of the muscles of the feet," Dr. Morton said.

This type of muscle spasticity can cause the feet to remain contracted in a position which makes it difficult or impossible for the patient to walk comfortably. "In these cases, one muscle or muscle group is overpowering the surrounding muscles, causing abnormal positioning," says Dr. Morton. "That's when the Botox will come into play.  We paralyze this one problem area to relax a tight muscle, and return the foot to a more normal position."

"It takes about two or three days from the initial Botox injection into the spastic muscle to start to see results, and about two weeks after the injections, we see a peak effect that can last about three months before slowly wearing off," Dr. Morton says.

"Once the Botox takes effect, we can either brace the foot or provide casting to provide stability and flexibility within that foot, so the patient has the chance to walk normally again," Dr. Green adds. 

The doctors said young children with cerebral palsy all the way up to the elderly with muscle spasms can benefit from Botox for the feet.

Drs. Morton and Green are among only a handful of doctors in the country providing this type of Botox treatment for the feet.  A recent KPLC-TV news story featuring them and their work was picked up by news stations in other states and they have been receiving calls from patients interested in this innovative new treatment from across the country.

"We are very excited about the success our patients have experienced with Botox injections and the potential it has to help many more people with these types of diabetic wound and spasticity problems," says Dr. Morton.

For more information, call Center for Orthopaedics at 721-7231 or visit