For as long as high heels have been a footwear option, the pain associated with wearing them has made the classic fashion choice feel, at times, borderline masochistic. Sure, there are plenty of alternatives for the uncomfortable shoes, but for those who are truly committed to height-boosting footwear or who may be dealing with something more serious, like bunions or plantar fasciitis (inflammation of the tissue that connects the heel bone to the toes) a neuromodulator, like Botox, might serve as an unlikely source of relief. Yes, foot Botox is a thing, and it's seeing a surge in popularity post-pandemic.
Neuromodulators like Botox are best known for their abilities to address aesthetic concerns, like minimizing the appearance of fine lines and wrinkles, so it might be surprising that injecting them into feet can help with pain. But physicians have actually been using the neurotoxin for non-cosmetic conditions since 1989, when the FDA first approved it to treat eye disorders like blepharospasm (uncontrollable blinking) and strabismus (crossed eyes). Since then, neuromodulators have found a wide range of uses — both "on label" and "off label" — to address conditions like "hyperhidrosis [or excessive sweating] on the feet, palms and underarms, as well as to mitigate foot pain associated with some foot conditions, like plantar fasciitis," says Dr. Kim Nichols, a board-certified dermatologist and founder of NicholsMD in Greenwich, CT, adding that her practice offers Botox treatments for more than 15 areas of the body.
With the post-pandemic return to offices, formal occasions such as weddings and events like fashion week, foot Botox is becoming an in-demand treatment. Plenty of heel wearers spent the past several years in flat shoes, slippers and socks while quarantining at home — and are now finding that returning to uncomfortable footwear is more of a pain than they'd expected.
"Strange as it may sound, two years of Covid have left many of us in even more agony from the sharp return of towering heels," says board-certified dermatologist and founder of AVA MD in Beverly Hills, Dr. Ava Shamban, of the rise in patients seeking care for foot pain. "Weight is distributed more evenly in flat shoes, [whereas] all of the pressure is thrust to the front of the foot in a heel."
Even if you're not wearing stilettos regularly just yet, New York City board-certified dermatologist Dr. Michelle Henry notes that factors like "sports, [tight] shoes, age or prolonged standing on flat surfaces can all lead to the development of plantar fasciitis," which presents as heel and arch pain, swelling and persistent discomfort that can last for months. But how exactly does Botox work to mitigate those symptoms? Says Nichols, "The neuromodulator paralyzes the muscles on your heel bone, causing the Substance P neurotransmitter [which modulates pain] to become inactive and in turn lead to less pain overall."
Plus, for those who are beginning to develop bunions or calluses — two unfortunate and painful side effects of wearing heels — Botox injections directly into the affected tissue can help prevent those conditions from getting worse, according to Dr. David J. Goldberg, Director of Cosmetic Dermatology and Clinical Research at Schweiger Dermatology Group in New York City. "[It's] the concept of pre-juvenation," he says of using Botox for these types of foot issues. "It applies to wrinkles just like it applies to calluses and bunions," he adds, in that it's a preventative step to consider before discomfort reaches unbearable levels. (He does also note that severe bunions will ultimately require surgery.)
Of course, as anyone who has a regular injectables habit knows, Botox isn't always a budget-friendly option. While injecting the glabellar lines between the eyebrows typically involves 10-25 units of the neurotoxin on average, Dr. Henry says that treating the feet can sometimes require 70 to 200 total units, with injections targeted at either the arch of the foot or calf muscle for plantar fasciitis patients. And at roughly $20 a unit (although prices fluctuate depending on your provider and location, among other factors), foot Botox can get expensive, fast. Depending on the severity of the condition, patients can expect to pay anywhere from a few thousand to tens (yes, tens) of thousands of dollars for the treatment.
The good news is that the benefits of foot Botox last about as long as they do elsewhere in the body; the increased movement of the feet (as compared with, say, the forehead) won't cause the neurotoxin to wear off more quickly. How many units you receive as well as your metabolism will contribute to determining the length of time the injectable will last, but three to four months is fairly typical.
There are a handful of risks to be aware of with this type of treatment, but nothing so serious that there should be a major cause for concern. "Although Botox is a great option for heel pain, injections may cause temporary side effects [like] muscle weakness in the treated area," notes Dr. Henry. "Your feet may even be swollen for a couple of days after getting the injection, but these side effects should subside in a few days."
As with any procedure that involves a neurotoxin, it's wise to take it easy for a few days after the injections, just in case there is an adverse reaction. That means swapping your heels for sneakers for a few days and avoiding strenuous activity. But overall, in the pantheon of options for pain relief, especially compared to surgery, the risk level and aftercare commitment is relatively minimal.
For those longing to return to their pre-pandemic daily high-heel habits or struggling with painful foot conditions, it might be time to visit a dermatologist or podiatrist to inquire if a neurotoxin like Botox can help.