Insertional Achilles Tendinopathy Treated With Botulinum Toxin: A Case Report

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.