This is a really interesting idea. I do botox now for migraine prevention, although digging around in the literature more broadly, treatment for various other conditions may be quite different. For migraines, it's multiple pricks around the forehead, temples, and back of the neck, while for knee arthritis, it's a single, deeper injection. I'm guessing targeting the foot would be more like migraine treatment, while targeting polyneuropathy with a spinal injection would be more like arthritis? I have to say that I would be more willing to just take a chance on local injections in the feet than I would on a spinal injection, which seems intuitively riskier.

The literature review says "However, further research is required to determine optimal dosing, treatment protocols, and the long-term effects of BTX-A in the management of neuralgia." That makes sense, of course.

So: how does one know whether any given medical professional actually has a clue how to get good results from what amounts to a promising, relatively new, off-label, use of the product? Any suggestions other than interviewing the person about their experience? I'm particularly concerned about the basic question of where to stick the needles, although optimal dosing is also a good issue to explore.