A proof of concept case series of botulinum toxin a treatment for ischemic feet due to Raynaud's phenomenon.

Stadelmeier, L F; Eeuwen, J E; Engmann, T F; Hilbig-Vlatten, L; Carroll, B J; Nashel, J; Dowlatshahi, A S · J Plast Reconstr Aesthet Surg · 2026

case_series · Level IV

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Abstract

Botulinum Toxin A (BTX-A) has shown benefit in treating Raynaud's phenomenon (RP) of the hands, but its use in the feet remains largely unreported. We present a retrospective case series of seven patients undergoing 11 BTX-A treatment sessions for refractory ischemic RP of the feet. Injections (100-150 units per foot) were administered under ultrasound guidance. At six weeks, 81.8% of treatment episodes demonstrated resolution of ulcers and/or gangrene. Pain significantly improved (p=0.013), with the proportion of pain-free cases increasing from 9.1% to 63.6%. One transient adverse event was observed. These findings suggest that BTX-A may represent a safe and promising treatment option for ischemic RP of the feet, warranting further investigation in prospective studies.