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

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.