Botox may not only be for plumping lips and filling in skin wrinkles.
Researchers at Washington University are using botox to help heal foot ulcers in diabetics.
Botox is made from clostridium botulinum, the same toxin that causes a life-threatening food poisoning called botulism. However, it is used in small doses to safely treat a number of medical conditions, including severe underarm sweating, severe muscle contractions and uncontrollable blinking.
About a dozen St. Louis diabetics have been participating in a trial study by Dr. Mary Hastings, PT DPT ATC of the physical therapy program at WU.
“These are people who have diabetes and have lost sensation on the bottom of the foot. They cannot feel pressure on their foot. The same problem happens to you or I if we have full sensation, but if it happens to us, we get off our foot or go see a doctor,” Hastings said.
“They don’t know there is a problem, and they basically walk a hole in their foot. We all hate pain, but it tells us something important – that there is something wrong and we need to address it.”
Botox injections work by weakening or paralyzing certain muscles or by blocking certain nerves. Hastings injects botox into the calf muscles of diabetic patients to increase the likelihood that when ulcers on the bottom of foot heal, they will not return. The botox works by slightly changing how the person walks to put less pressure on the ball of the foot.
“They probably would not be able to walk as fast or take as big a step – it changes the pace temporarily. It’s a short term to try to protect the skin as it gets stronger,” Hastings explained.
“The importance is as the strength comes back, it’s gradually increasing the pressure on the front of foot so the tissue becomes tolerant of the stress of everyday activities.”
Forty-six-year-old Derrick C. Cooper has been diabetic for 19 years. An issue Cooper was having brought him into the study about a year-and-a-half ago.
“I had a blister on my big toe on the bottom,” he said.
“There were at least two different times that I received injections in my calf, probably about a month or so apart.”
The effects last about two to four months.
Hastings said the typical regimen is one session with six injections of botox.
After the injection(s), Hastings and her research team conducted follow-up with each patient.
“We follow them by phone for quite a while. We healed all of their ulcers. We are completely blinded to what treatment they get. The primarily thing we are trying to figure out is how much can we weaken the calf,” Hastings said.
Although neither Hastings nor Cooper knows for certain if he received the botox or the placebo, Cooper said the treatment was beneficial.
He said, “I do think they helped me in terms of the overall process. I experienced relief because the blister was recurring and since that time, I have not experienced a recurrence.”
Cooper said he has been blister-free for eight or nine months. He noticed another effect in the way he walks.
“I am more comfortable walking,” Cooper said. “I had a bit of a limp from diabetes peripheral nerve damage to lower extremities. The limp is less pronounced.”
Cooper also learned how to exercise in the process.
“They provided the rubberized strap to put at the base of my toes and pull it up and down. I have gotten into the habit of when I lay down I do some ankle exercises and also with my legs,” Cooper said.
Cooper also liked the exercises and the recording the progress of his functional ability.
Hastings continues to work on preliminary data and said more study is needed. She wants to expand her foot ulcer study by another 40 diabetics experiencing ulcers on the bottom of their feet.
If the pilot data works out, Hastings would like to expand the study to other facilities that treat diabetics and foot ulcers. For more information, call 314-362-2407.