Neuromodulators like Botox are best known for their abilities to address aesthetic concerns, such as 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."

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