For a more effective botox injection, the needle must be guided into the targeted muscle by a musculoskeletal radiologist using either ultrasound or CT guidance. Ultrasound is used for superficial muscles like plantaris. CT is used for deeper muscles like pyriformis.  

The procedure does not require an anesthetic and takes 15 minutes.

The beneficial effects of the injection will commence within 5 to 7 days. 

The effects of the toxin will wear off after 4-6 months and the patient may require a repeat injection.

Neck and back muscles, upper and lower limb muscles in spasm. Specific muscles injected include piriformis, vastus lateralis and plantaris. Injection of plantaris and gastrocnemius muscles is also performed for functional popliteal artery entrapment. 

The patient will notice reduction in spasm of the injected muscle. If the injected muscle is causing joint pain, following injection the joint pain should reduce and joint mobility should increase. The patient will experience an improved quality of life. 

Botox is a commonly injected, safe drug that is well tolerated. The main effect of the injection is muscle weakness. Rare side effects include post injection site pain, headache, rash, dry mouth, flu like symptoms and difficulty swallowing. If the patient experiences any of these side effects, they should contact the radiologist who performed their injection. 

Botox injection is contraindicated when the patient has botox hypersensitivity, Myasthenia Gravis or signs of infection.

Botox injections in pregnant women should be cautioned and is only recommended when the benefit justifies any potential risk to the fetus. Breastfeeding is not recommended following injection. 

Yes, it is recommended that you have a driver take you home after injection.

It is recommended that the patient rest for 3-4 days following injection and then gradually increases load back to the pre injection level from days 5 to 7.