Role of Platelet Rich Plasma in Chronic Plantar Fasciitis: A Prospective Study

Abstract

Introduction Autologous platelet rich plasma (PRP) local injection has been recently proposed as a treatment of plantar fasciitis. The autologous PRP does not have much side effects compared to steroid injections. So far PRP injections have shown promising results in various studies. This study assessed the efficacy of a single local injection of PRP in chronic unilateral plantar fasciitis through a prospective case series. Methodology A hospital-based prospective case series of 30 unilateral plantar fasciitis patients with symptom duration of 6 months or more were included in the study. All patients included in the study were assessed clinically and by visual analogue score for heel pain, AHS component of AOFAS and FADI scores before injection and at 6 and 12 week followup. USG measurement of plantar fascia thickness was done at pre-injection and at 12 weeks follow-up. All patients were observed for 12 weeks. ResultsThe mean age was 39 years (range 20-55 years). The pre-injection VAS score for heel pain was 6.5 ± 1.1 which improved to 2.7 ± 0.5 and 1.8 ± 0.8 at 6 and 12 week respectively and difference was significant (p < 0.001). The baseline FADI and AHS component of AOFAS scores were 53.1 ± 9.0 and 72.2 ± 5.7 which improved to 65.5 ± 5.3 and 76.1 ± 4.5 at 6 weeks and, 77.9 ± 4.4 and 85.7 ± 4.6 at 12 weeks respectively which was significant (p < 0.001). The baseline mean plantar fascia thickness was 4.9 ± 0.3 mm which was significantly (p < 0.001) reduced to 3.9 ± 0.3 mm at 12 weeks post PRP injection. All pairwise comparisons by the post-hoc Wilcoxon signed rank test with p-value adjustment were also significant. ConclusionThe short-term results of single dose PRP injections shows clinical and statistically significant improvements in VAS for heel pain, functional outcome scores and plantar fascia thickness measured by USG. This study concludes that local PRP injection is a viable management option for chronic plantar fasciitis. KeywordsPlantar fasciitis • Platelet rich plasma • Ultrasound • USG • Plantar fascia thickness * Lakshmana Das

Platelet Rich Plasma Injection in the Treatment of a Recalcitrant Plantar Fasciitis: A Case Study

“…A recent prospective study of 60 cohorts conducted to investigate the functional and clinical outcome in patients with plantar fasciitis treated by autologous PRP injection, found statistically significant improvements in pain reduction and lower limb function at 12 weeks' follow-up.7 Similarly, other authors, have reported improvements in NPS and American orthopedic foot and ankle society (AOFAS) scores following local injection of platelet rich plasma. The findings of these studies are consistent with this case study [1,30,31].…”

Platelet-Rich Plasma vs Autologous Blood Injection to Treat Plantar Fasciitis: A Prospective Randomized, Double-Blinded, Controlled Trial

“…In patients who do not respond to first-line treatments and become chronic, various methods including CS injections, PRP injections, extracorporeal shock-wave therapy, or dry needling, may be considered. 2,4,9,10,13,14,[17][18][19][20][21][22][23][25][26][27][28]31,39 CS injections have become a popular second-line treatment method, with rapid improvement in pain scores in patients who do not respond to noninvasive conservative treatment methods. Although the efficacy of CS injection in the treatment of PF was previously thought to be due to the anti-inflammatory activity of CS; the prostaglandin-related anti-inflammatory effect of CS has become controversial after histopathologic studies revealed that PF is a degenerative condition and not an inflammatory process.…”

“…Although there are numerous causes of heel pain, the most common in adults aged >40 years is plantar fasciitis (PF). 14,18 PF is bilateral in approximately 30% of the patients. A sharp pain under the heel and "start-up pain," which is more pronounced especially in the morning, are diagnostically important.…”

“…In patients who do not benefit from first-line treatments and develop chronic PF, various methods including corticosteroid (CS) injections, platelet-rich plasma (PRP) injections, extracorporeal shock-wave therapy, and dry needling may be considered. 1,2,4,5,6,9,10,13,14,[17][18][19][20][21][22]23,[25][26][27][28]31,39 Previous studies suggest that PRP injection could help repair of degenerative plantar fascial tissue due to high growth factor, stimulation of angiogenesis, and the potential anabolic effect on collagen matrix degeneration. 2,9,12,15,23,25 The clinical improvement, including improvements in pain scores and functionality, seen after PRP injections has been thought to be longer lasting with PRP injections compared with CS injections, potentially because of this purported regeneration effect, and has become an alternative to CS injections.…”

“…In patients who do not benefit from first-line treatments and develop chronic PF, various methods including corticosteroid (CS) injections, platelet-rich plasma (PRP) injections, extracorporeal shock-wave therapy, and dry needling may be considered. 1,2,4,5,6,9,10,13,14,17-22,23,25-28,31,39…”