Chronic Plantar Fasciitis: Effect of Platelet-Rich Plasma, Corticosteroid, and Placebo
Abstract
Plantar fasciitis is a common cause of heel pain. It is a disabling disease in its chronic form. It is a degenerative tissue condition of the plantar fascia rather than an inflammation. Various treatment options are available, including nonsteroidal anti-inflammatory drugs, corticosteroid injections, orthosis, and physiotherapy. This study compared the effects of local platelet-rich plasma, corticosteroid, and placebo injections in the treatment of chronic plantar fasciitis. In this double-blind study, patients were divided randomly into 3 groups. Local injections of platelet-rich plasma, corticosteroid, or normal saline were given. Patients were assessed with the visual analog scale for pain and with the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle and Hindfoot score before injection, at 3 weeks, and at 3-month follow-up. Mean visual analog scale score in the platelet-rich plasma and corticosteroid groups decreased from 7.44 and 7.72 preinjection to 2.52 and 3.64 at final follow-up, respectively. Mean AOFAS score in the platelet-rich plasma and corticosteroid groups improved from 51.56 and 55.72 preinjection to 88.24 and 81.32 at final follow-up, respectively. There was a significant improvement in visual analog scale score and AOFAS score in the platelet-rich plasma and corticosteroid groups at 3 weeks and at 3-month follow-up. There was no significant improvement in visual analog scale score or AOFAS score in the placebo group at any stage of the study. The authors concluded that local injection of platelet-rich plasma or corticosteroid is an effective treatment option for chronic plantar fasciitis. Platelet-rich plasma injection is as effective as or more effective than corticosteroid injection in treating chronic plantar fasciitis. [Orthopedics. 2016; 39(2):e285–e289.]
- 1.Irving DB, Cook JL, Menz HB. Factors associated with chronic plantar heel pain: a systematic review. J Sci Med Sport. 2006; 9:11–22.
10.1016/j.jsams.2006.02.004 Crossref MedlineGoogle Scholar - 2.Porter MD, Shadbolt B. Intralesional corticosteroid injection versus extracorporeal shock wave therapy for plantar fasciopathy. Clin J Sport Med. 2005; 15:119–124.
10.1097/01.jsm.0000164039.91787.dc Crossref MedlineGoogle Scholar - 3.Goff JD, Crawford R. Diagnosis and treatment of plantar fasciitis. Am Fam Physician. 2011; 84:676–682. MedlineGoogle Scholar
- 4.Wolgin M, Cook C, Graham C, Mauldin D. Conservative treatment of plantar heel pain: long-term follow-up. Foot Ankle Int. 1994; 15:97–102.
10.1177/107110079401500303 Crossref MedlineGoogle Scholar - 5.Roles NC, Maudsley RH. Radial tunnel syndrome: resistant tennis elbow as a nerve entrapment. J Bone Joint Surg Br. 1972; 54:499–508. Crossref MedlineGoogle Scholar
- 6.Buchbinder R. Clinical practice: plantar fasciitis. N Engl J Med. 2004; 350:2159–2166.
10.1056/NEJMcp032745 Crossref MedlineGoogle Scholar - 7.Lemont H, Ammirati K, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003; 93:234–237.
10.7547/87507315-93-3-234 Crossref MedlineGoogle Scholar - 8.Barrett SL, Robert OM. Plantar fasciitis and other causes of heel pain. Am Fam Physician. 1999; 59:2200–2206. MedlineGoogle Scholar
- 9.Fenwick SA, Hazleman BL, Riley GP. The vasculature and its role in the damaged and healing tendon. Arthritis Res. 2002; 4:252–260.
10.1186/ar416 Crossref MedlineGoogle Scholar - 10.Molloy T, Wang Y, Murrell G. The roles of growth factors in tendon and ligament healing. Sports Med. 2003; 33:381–394.
10.2165/00007256-200333050-00004 Crossref MedlineGoogle Scholar - 11.Monto RR. Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis. Foot Ankle Int. 2014; 35:313–318.
10.1177/1071100713519778 Crossref MedlineGoogle Scholar - 12.Shetty VD, Dhillon M, Hegde C, Jagtap P, Shetty S. A study to compare the efficacy of corticosteroid therapy with platelet-rich plasma therapy in recalcitrant plantar fasciitis: a preliminary report. Foot Ankle Surg. 2014; 20(1):10–13.
10.1016/j.fas.2013.08.002 Crossref MedlineGoogle Scholar - 13.Peerbooms JC, van Laar W, Faber F, Schuller HM, van der Hoeven H, Gosens T. Use of platelet rich plasma to treat plantar fasciitis: design of a multi centre randomized controlled trial. BMC Musculoskelet Disord. 2010; 11:69.
10.1186/1471-2474-11-69 Crossref MedlineGoogle Scholar - 14.Aksahin E, Dogruyol D, Yüksel HY, The comparison of the effect of corticosteroids and platelet-rich plasma (PRP) for the treatment of plantar fasciitis. Arch Orthop Trauma Surg. 2012; 132:781–785.
10.1007/s00402-012-1488-5 Crossref MedlineGoogle Scholar - 15.Lee TG, Ahmad TS. Intralesional autologous blood injection compared to corticosteroid injection for treatment of chronic plantar fasciitis: a prospective, randomized, controlled trial. Foot Ankle Int. 2007; 28:984–990.
10.3113/FAI.2007.0984 Crossref MedlineGoogle Scholar - 16.Martinelli N, Marinozzi A, Carnì S, Trovato U, Bianchi A, Denaro V. Platelet-rich plasma injections for chronic plantar fasciitis. Int Orthop. 2013; 37:839–842.
10.1007/s00264-012-1741-0 Crossref MedlineGoogle Scholar - 17.Kumar V, Millar T, Murphy PN, Clough T. The treatment of intractable planter fasciitis with platelet-rich plasma injection. Foot (Edinb). 2013; 23:74–77.
10.1016/j.foot.2013.06.002 Crossref MedlineGoogle Scholar - 18.Wilson JJ, Lee KS, Miller AT, Wang S. Platelet-rich plasma for the treatment of chronic planter fasciopathy in adults: a case series. Foot Ankle Spec. 2014; 7:61–67.
10.1177/1938640013509671 Crossref MedlineGoogle Scholar - 19.Ragab EM, Othman AM. Platelets rich plasma for treatment of chronic plantar fasciitis. Arch Orthop Trauma Surg. 2012; 132:1065–1070.
10.1007/s00402-012-1505-8 Crossref MedlineGoogle Scholar - 20.Barrett S, Erredge S. Growth factors for chronic plantar fasciitis?Podiatry Today. 2004; 17:37–42. Google Scholar
- 21.Tsai WC, Wang CL, Tang FT, Hsu TC, Hsu KH, Wong MK. Treatment of proximal plantar fasciitis with ultrasound-guided steroid injection. Arch Phys Med Rehab. 2000; 81:1416–1421.
10.1053/apmr.2000.9175 Crossref MedlineGoogle Scholar - 22.Cunnane G, Brophy DP, Gibney RG, FitzGerald O. Diagnosis and treatment of heel pain in chronic inflammatory arthritis using ultrasound. Semin Arthritis Rheum. 1996; 25:383–389.
10.1016/S0049-0172(96)80003-5 Crossref MedlineGoogle Scholar - 23.Kane D, Greaney T, Shanahan M, The role of ultrasonography in the diagnosis and management of idiopathic plantar fasciitis. Rheumatology (Oxford). 2001; 40:1002–1008.
10.1093/rheumatology/40.9.1002 Crossref MedlineGoogle Scholar - 24.Russell RP, Apostolakos J, Hirose T, Cote MP, Mazzocca AD. Variability of platelet-rich plasma preparations. Sports Med Arthrosc. 2013; 21:186–190.
10.1097/JSA.0000000000000007 Crossref MedlineGoogle Scholar - 25.Arnoczky SP, Shebani-Rad S. The basic science of platelet-rich plasma (PRP): what clinicians need to know. Sports Med Arthrosc. 2013; 21:180–185.
10.1097/JSA.0b013e3182999712 Crossref MedlineGoogle Scholar
