BackgroundA large proportion of painful diabetic neuropathy cases either do not respond or are intolerant to the currently available oral and physical therapies. There is encouraging evidence from a small number of studies that those patients can improve using botulinum toxin injection. The aim of the study was to evaluate the effect of intradermal injection of botulinum toxin type A on painful diabetic neuropathy. Eight adult patients with diabetic peripheral neuropathy (DPN), confirmed by nerve conduction studies, were refractory to a minimum of two neuropathic pain treatments for 6 months or more were recruited. All cases received intradermal injection of 48 units of botulinum toxins—type A in each foot in 6×4 distribution. Follow-up was done after 8 weeks using the Neuropathic Pain Scale (NPS), Pittsburgh Sleep Quality Index (PSQI), and Overall Disability Sum Scale (ODSS).ResultsAfter 8 weeks, there was a significant change in NPS from 55.8 (7.8) to 38.5 (8.1) (p value 0.007), also there was significant improvement in ODDS from 4 (IQR, 2.25-4.75) to 2.5 (IQR, 0.5-3) (p value 0.01). However, there was no significant change in PSQI.ConclusionBotulinum toxin type A injection is a promising treatment option in Egyptian DPN adults in this study.