Botox for Spasticity in Legs and Tight Leg Muscles

Botox for Spasticity in Legs

Botox is basically a neurotoxin that paralyzes muscles. Its paralyzing properties are used in medical practice in patients who have leg spasticity. It is commonly used for spasticity in the legs, neck, and other areas of the body especially after stroke and in patients with cerebral palsy.

Botox? in legs? yes, you heard it right. It has numerous uses including fillers, beauty, and pain relief. In this article, we will learn about its uses especially Botox for spasticity in legs, sports injuries, and children with cerebral palsy.

What is Botox?

Botox is a type of bacterial toxin that acts on acetylcholine receptors. This inhibits the release of this neurotransmitter leading to the inhibition effect of acetylcholine.

This is now used in multiple disorders mostly due to muscle activity. This toxin is used in minimal quantity as it can be absorbed into systemic circulation which will end up in patients with systemic effects.

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Botox for Sports Injuries:

Legs contain some of the strongest muscles of the body and spasms in these muscles can interfere with normal walking running and even sitting.

Injuries can result in inflammation and spasms of these muscles that will eventually end up in a patient with limited mobility and may be a deformity.

Botox toxin act here as a relaxing agent that will relieve the spasm that was because by injury and inflammation.

This is injected into legs in very small quantities because of its systemic adverse effects. Their dosing is guided according to muscle mass and EMG studies results.

How effective is Botox for Sports Injuries:

Botox is used to treat sports injuries and painful knee conditions. Painful knee affects more than one in eight sportsmen.

Another painful condition the lateral patellofemoral condition is seen commonly in both professional and amateur runners and cyclists.

This is because of continuous injury leading to inflammation in the tensor fascia lata. this leads to sharp pain in the front and lateral side of the knee joint.

Ultrasound-guided Botulinum (Botox) was injected into 45 patients, 69% of patients had pain relief with no need for further medical intervention followed for 5 years.

According to research patients who were treated with a conservative approach and physiotherapy for their lateral patellofemoral syndrome 89% had ongoing pain and 74% reduced activity.

Currently, physiotherapy and intralesional steroids are commonly administered in sports injuries. But this approach is partially effective.

For this reason, Botox use is currently trending and a better option for such conditions. As it provides optimal and quick relief and effects last longer.

Its effect can be augmented with the adjunct use of physiotherapy and steroids. The only problem with this is that it has to be done in multiple sessions. Injections are less convenient than pills.

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Calf Reduction with Botox:

Another condition involving leg muscle that can be treated with Botox Injection is calf reduction. Some people have genetically big calf muscles.

These oversized calf muscles are not because of fat deposition but are because of large calf muscles.

Exercise and dietary modification may help some people but the results are usually suboptimal. In contrast to this conventional therapy, more physicians and patients opt for Botox therapy.

How effective is BOTOX for Calf reduction?

Reduction of the calf is not a question of dietary modification or exercise. Initially, the only effective treatment was invasive surgery.

Better outcomes are expected with multisession botox therapy. It’s very effective and may result in a reduction of 2 cm of the calf in one month. The only drawback is that it requires an injection after every 3-4 months.

Before BOTOX Injection:

Before injection, you will be advised to shave your leg. No other precautions are advised.

After BOTOX Injection:

You will be advised against exercise and yoga. The effects of BOTOX may last for up to 6 months.

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Botox for Spasticity and Pain in the Legs:

Botulinum toxin is a toxin that is commercially available by name of Botox. It is commonly known for its cosmetic effects & use but it is also effective in treating pain caused by muscle spasms.

The mechanism of pain relief is the release of muscle spasms that lead to muscle relaxation eventually leading to pain relief.

Who is eligible for Botox Therapy?

Patients with identifiable trigger points mean permanently contracted muscles. Muscles that produce pain on minimal compression are called trigger points.

These trigger points are sometimes labeled as knots. These points are secondary to either trauma or degenerative changes.

A patient with these muscle knots or trigger points is a good candidate for botox therapy. Especially those patients who fail to show a conservative approach or fail to show a good response to physiotherapy are candidates to be considered for botox therapy.


The treatment plan for spasticity

There are numerous neurological disorders like cerebral palsy and multiple sclerosis (MS) that lead to increased muscle tone in both upper limbs and lower limbs.

In this case, the first line of defense is physiotherapy with passively stretching if this fails then the patient can be considered for botox therapy.

According to various researchers, Botox is safe and effective in such conditions and is safe even in children.

How Botox relieves muscle spasms?

When there is an injury nervous system there is a flood of signals to the muscles from the nervous system.

This lead to increased and sustained muscle tone. eventually, the muscle goes into spasm and this will affect muscle activity.

What Botox does is that it blocks the effect of these signals leading to the relaxation of muscles and increased mobility.

Who is eligible for Botox Therapy?

The final decision of whether to undergo any procedure or not will be based on the treating physician.

But when spasticity is caused by few muscles then in that case that patient is a good candidate for it. All these decisions are made after EMG studies. Because without diagnostic workup diagnosis is difficult.

What to expect after Botox administration?

Multiple types of research are already going on to assess the efficiency of this in cases of spasticity. But until now data suggests that botox is a safe and effective option in such cases.

Large muscle and small dosing may necessitate repeated dosing. Its effects can be observed in a few days which may last for 4 to 6 months after administration.

Benefits of Botox Injections:

  • Botox is effective and provides immediate relief.
  • It is very well tolerated
  • It is non-invasive and does not need anesthesia.

Cons of Botox Injections:

  • Multiple sessions may be required
  • Body adaptation leads to reduced effectiveness
  • Less convenient than tablets

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Botox for Cerebral Palsy

This is another specific neurological disorder that affects patients from childhood. This is because of ischemic injury during childbirth.

This also affects the upper and lower limb and neck muscles. Spasm of muscles tilts body segment to that side.

In the leg muscles, spasm makes the patient walk with difficulty. As calf muscles are very strong their spasm pulls the foot into dorsiflexion and inversion. Because of this patients walk on the balls of their feet.

This posture makes walking difficult, especially on flat surfaces. Once these patients are initiated on this therapy their muscles relax leading to a more normal position. This change in the posture of the foot leads to increased stability and reduced risk of falls.

How Botox helps patients with Cerebral Palsy?

In the case of Cerebral Palsy, the muscle of the groin and buttock have increased tone that leads to scissoring of the legs.

This makes standing and walking difficult for the patient. Once these muscles are injected with Botox muscles relax which leads to reduced spasms. This eventually makes patients walk easily and can have a normal gait.


Botox is a toxin that is released by a bacterium which in high doses can have fatal effects as it relaxes muscles.

Our whole breathing is carried out by these muscles. But in low doses, it can be used as a miracle drug in numerous conditions for which treatment was not very effective or had to have a long journey of rehabilitation and recovery.

Read: Botox uses, Dose, Sites of administration, Side effects, and Brands

What do you think?

Written by Dr. Ahmed

I am Dr. Ahmed (MBBS; FCPS Medicine), an Internist and a practicing physician. I am in the medical field for over fifteen years working in one of the busiest hospitals and writing medical posts for over 5 years.

I love my family, my profession, my blog, nature, hiking, and simple life. Read more about me, my family, and my qualifications

Here is a link to My Facebook Page. You can also contact me by email at or at My Twitter Account
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