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INTRODUCTION
Chronic plantar fasciitis is a common but sometimes difficult condition to successfully treat. Platelet rich plasma (PRP), a concentrated bioactive component of autologous blood that is rich in cytokines and other growth factors, was compared with cortisone injection in the treatment of severe cases of plantar fasciitis resistant to traditional non-operative paradigms.
METHODS
Thirty-six patients (16 males, 20 females) with severe chronic plantar fasciitis who had failed traditional non-operative treatment (rest, heel lifts, PT, NSAIDS, cam walker immobilization, night splinting, local modalities) were randomized into two study groups and evaluated prospectively. All patients had pre-treatment MRI and ultrasound studies consistent with plantar fasciitis. Group 1 was treated with a single ultrasound-guided injection of 40 mg methylprednisolone at the injury site and Group 2 was treated with a single ultrasound-guided injection of un-buffered autologous PRP at the injury site. All patients were then immobilized fully weight bearing in a cam walker for two weeks, started on eccentric home exercises and then allowed to return to normal activities as tolerated and without support.
RESULTS
Group 1 had an average age of 59 (24-74) and had failed 5.4 months (4-24) of standard non-operative management and had pre-treatment AOFAS scores of 52 (24-60). The PRP group had an average age of 51 (21-67) and had failed 5.7 months (4-26) of standard non-operative management and had pre-treatment AOFAS scores of 37 (30-56). Post-treatment AOFAS scores in Group 1 initially improved to 81 (60-90) at three months but decreased to 74 (56-85) at six months and dropped further to 58 (45-77) at 12 months follow up. Post-treatment AOFAS scores in Group 2 improved to 95 (84-90) at three months and remained excellent at 94 (87-100) at six months and stayed at 94 (86-100) at 12 months follow up (CI 95% P=0.001). No patients were lost to follow up.
DISCUSSION AND CONCLUSION
This study suggests that platelet rich plasma injection is significantly more effective and durable than cortisone injection for the treatment of severe chronic plantar fasciitis refractory to traditional non-operative management.
Re: Platelet Rich Plasma for Musculoskeletal Conditions
The comparison of the effect of corticosteroids and platelet-rich plasma (PRP) for the treatment of plantar fasciitis.
Akşahin E, Doğruyol D, Yüksel HY, Hapa O, Doğan O, Celebi L, Biçimoğlu A Arch Orthop Trauma Surg. 2012 Mar 8;
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INTRODUCTION: In this study, the results of local injection of platelet-rich plasma (PRP) and corticosteroids in the treatment of plantar fasciitis were compared.
PATIENTS AND METHODS: Sixty patients who were diagnosed as plantar fasciitis and treated conservatively for at least 3 months and had no response to conservative treatment modalities were involved in this study. The first 30 consecutive patients were treated by local injection of 2 mL of 40 mg Methylprednisolone with 2 mL of 2% prilocaine (metilprednizalone) and the second 30 patients were treated by injecting 3 mL PRP after 2 mL of 2% prilocaine injection. Patients were evaluated according to the modified criteria of the Roles and Maudsley scores and visual analog scale before injection and 3 weeks and 6 months following injection.
RESULTS: The mean VAS heel pain scores measured 6 months after treatment were 3.4 in steroid group and 3.93 in PRP group, and the scores in both groups were significantly lower when compared with pretreatment levels (6.2 in steroid group and 7.33 in PRP group). There was no significant difference between steroid and PRP groups in visual analog scale scores and modified criteria of the Roles and Maudsley scores measured at 3 weeks and 6 months (P > 0.05).
CONCLUSION: Our results revealed that both methods were effective and successful in treating plantar fasciitis. When the potential complication of corticosteroid treatment was taken into consideration, PRP injection seems to be safer and at least having same effectivity in the treatment of plantar fasciitis.
Re: Platelet Rich Plasma for Musculoskeletal Conditions
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Originally Posted by NewsBot
The comparison of the effect of corticosteroids and platelet-rich plasma (PRP) for the treatment of plantar fasciitis.
Akşahin E, Doğruyol D, Yüksel HY, Hapa O, Doğan O, Celebi L, Biçimoğlu A Arch Orthop Trauma Surg. 2012 Mar 8;
Platelet-rich plasma for managing calcaneus tendon tendinopathy and plantar fasciitis
López-Gavito E, Gómez-Carlín LA, Parra-Téllez P, Vázquez-Escamilla J. Acta Ortop Mex. 2011 Nov-Dec;25(6):380-5.
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INTRODUCTION:
Non-surgical treatment of Achilles tendinopathies ad plantar fasciitis has shown good results in up to 90% of cases. However, the remaining 10% of patients with these conditions represent a true challenge for the orthopedic surgeon. New technologies for the development of orthobiologic materials make it possible to use platelet-rich plasma (PRP) as an alternative to treat cases that have been refractory to prior treatment and that have a chronicity exceeding 12 months.
MATERIAL AND METHODS:
Prospective, analytical study. Patients with diagnosis of Achilles tendinopathy, plantar fasciitis or both, with a course of more than 12 months, previously treated with non-surgical alternatives, without any clinical improvement. The AOFAS hindfoot scale was used, together with the Visual Analog Scale (VAS) for pain, and photographic documentation at 2, 4, 8 and 12 months after infiltration. A treatment program that included immobilization, NSAIDs, eccentric exercises for the Achilles-calcaneal-plantar system and strengthening of the sural triceps was established. The statistical analysis included measurements of the central trend and scatter with the SPSS 15.
RESULTS:
A sample consisting of 10 patients (12 feet) that met the diagnostic and inclusion criteria was obtained. Mean age at the time of presentation was 43 years (range 23-56), with females being predominant (70%) and 50% laterality for the right and left feet. The initial AOFAS score was 39 (range 28-68) and the VAS score was 9 (range 7-10). By week 16 the AOFAS score had increased to 97 (range 88-99) and the VAS score was 2 (range 1-4). All patients resumed independent gait.
CONCLUSION:
The use of PRP in patients with Achilles tendinopathy and plantar fasciitis is an effective and safe alternative for the management of patients with a poor response to conventional non-surgical treatment. Other non-surgical modalities are recommended besides PRP for the treatment of these patients to achieve appropriate results.
Fleur Allen thought she had tried everything possible to alleviate the crippling pain she has suffered in the soles of her feet for the past four years.
Steroids, painkillers, insoles, electric shocks, ultrasound and physiotherapy – nothing helped.
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The pain was caused by damaged tissue in her feet, a condition known as plantar fasciitis.
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Now, a simple procedure which involved taking a teaspoonful of blood out of her arm and injecting it into her foot has proved the unlikely remedy.
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Dr Wheeler said: "Blood contains a lot of different things, including chemicals which promote healing.
"The injections almost guarantee success to the vast majority of patients.
BACKGROUND:
Plantar fasciitis is a common cause of heel pain in adults. Many treatment options exist. Platelets rich plasma (PRP) is derived from autologous blood and contains high concentration of growth factors necessary for tissue healing. The use of PRP in the treatment of plantar fasciitis is a fairly recent and evolving concept. The purpose of our work was to study the effectiveness of PRP treatment for chronic plantar fasciitis.
MATERIALS AND METHODS:
Between February 2010 and June 2011, 25 patients with chronic plantar fasciitis with a mean age of 44 years were treated by PRP injection and included in this prospective study. All patients were assessed for the pain on Visual Analogue Scale (VAS) pre-injection and post-injection. Using ultrasound, the thickness of the plantar fascia was measured prior to the injection of PRP and at each visit of follow-up after injection. The mean follow-up was 10.3 months.
RESULTS:
Using a visual analog pain scale, the average pre-injection pain in patients of was 9.1 (range 8-10). Prior to injection, 72 % of patients had severe limitation of activities, and 28 % of patients had moderate limitation of activities. Average post-injection pain decreased to 1.6. Twenty-two patients (88 %) were completely satisfied, two patients (8 %) were satisfied with reservations, and one patient (4 %) was unsatisfied with using the visual analog scale. Fifteen patients (60 %) had no functional limitations post-injection and eight patients (32 %) had minimal functional limitations. Two patients (8 %) had moderate functional limitations post-injection. Twenty PRP injections. Ultrasonography, we noted significant changes not only in thickness but also in the signal intensity of the plantar fascia after PRP injection. None of our patients experienced any complications from PRP injection at the end of follow-up period.
CONCLUSION:
Injection of PRP is safe and doesn't affect the biomechanical function of the foot. Our successful early findings with injection of PRP indicate that this may become a very commonly used modality in treating this difficult condition.
Platelet-rich plasma for managing calcaneus tendon tendinopathy and plantar fasciitis
López-Gavito E, Gómez-Carlín LA, Parra-Téllez P, Vázquez-Escamilla J. Acta Ortop Mex. 2011 Nov-Dec;25(6):380-5.
Quote:
INTRODUCTION:
Non-surgical treatment of Achilles tendinopathies ad plantar fasciitis has shown good results in up to 90% of cases. However, the remaining 10% of patients with these conditions represent a true challenge for the orthopedic surgeon. New technologies for the development of orthobiologic materials make it possible to use platelet-rich plasma (PRP) as an alternative to treat cases that have been refractory to prior treatment and that have a chronicity exceeding 12 months.
MATERIAL AND METHODS:
Prospective, analytical study. Patients with diagnosis of Achilles tendinopathy, plantar fasciitis or both, with a course of more than 12 months, previously treated with non-surgical alternatives, without any clinical improvement. The AOFAS hindfoot scale was used, together with the Visual Analog Scale (VAS) for pain, and photographic documentation at 2, 4, 8 and 12 months after infiltration. A treatment program that included immobilization, NSAIDs, eccentric exercises for the Achilles-calcaneal-plantar system and strengthening of the sural triceps was established. The statistical analysis included measurements of the central trend and scatter with the SPSS 15.
RESULTS:
A sample consisting of 10 patients (12 feet) that met the diagnostic and inclusion criteria was obtained. Mean age at the time of presentation was 43 years (range 23-56), with females being predominant (70%) and 50% laterality for the right and left feet. The initial AOFAS score was 39 (range 28-68) and the VAS score was 9 (range 7-10). By week 16 the AOFAS score had increased to 97 (range 88-99) and the VAS score was 2 (range 1-4). All patients resumed independent gait.
CONCLUSION:
The use of PRP in patients with Achilles tendinopathy and plantar fasciitis is an effective and safe alternative for the management of patients with a poor response to conventional non-surgical treatment. Other non-surgical modalities are recommended besides PRP for the treatment of these patients to achieve appropriate results.
Plantar fasciitis presents clinically as pain in the inner heal, which is the result of degeneration of the plantar fascia, an arch supporting ligament of the foot. It manifests predominantly in those subjected to sustained weight bearing or repetitive pounding activities. Plantar fasciitis is the most common cause of inferior foot pain. Although most cases resolving within 6 months, traditional treatment regiments such as orthotics and physiotherapy are occasionally unsuccessful in treating this limitation leading to chronic symptoms (Neufeld & Cerrato, 2008; Rompe, 2009; Roxas, 2005).
Platelets are central players in clotting, inflammation and the wound healing response. Research has shown the potential of platelet rich plasma to accelerate wound healing in a variety of conditions including maxillo-fascial and plastic surgery, chronic wound healing and orthopaedics. Autologous Conditioned Plasma (ACP) is a novel treatment that may accelerate the healing of injured tissue. Treatment with ACP involves taking a blood sample from the patient, isolating the platelets and injecting them back into that patient at the injury site
Platelet-rich plasma injections for chronic plantar fasciitis.
Martinelli N, Marinozzi A, Carnì S, Trovato U, Bianchi A, Denaro V. Int Orthop. 2012 Dec 19
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PURPOSE:
The purpose of this study was to assess the safety and preliminary clinical results of platelet-rich plasma (PRP) injections for treating chronic plantar fasciitis.
METHODS:
Fourteen consecutive patients with chronic plantar fasciitis receiving three injections of PRP into the plantar fascia were assessed 12 months after the procedure. The modified Roles and Maudsley score and a visual analogue scale (VAS) for pain were used to evaluate the clinical results.
RESULTS:
According to criteria of the Roles and Maudsley score, at 12 months of follow-up, results were rated as excellent in nine (64.3 %), good in two (14.3 %), acceptable in two (14.3 %) and poor in one (7.1 %) patient. VAS for pain was significantly decreased from 7.1 ± 1.1 before treatment to 1.9 ± 1.5 at the last follow-up (p < 0.01).
CONCLUSIONS:
In this single-centre, uncontrolled, prospective, preliminary study, results indicate that treating chronic plantar fasciitis with PRP injections is safe and has the potential to reduce pain.
Chronic muscle & tendon injuries are one of the problems which are encountered from human being since last long time.These injuries are generally repetitive strain injuries,commonly found in athletes.There are various treatments which include conservative methods in initial stages to surgery in later stages.On minimal invasive aspect Ultrasound-guided fenestration and tenotomy surgery has been used with good results as a effective treatment of chronic tendinopathies [1, 2]. There are various injectable agents were also researched including simple solutions such as hyperosmolar dextrose [3] (prolotherapy) to complex orthobiologic agents such as bone morphogenic protein [4], but none have achieved uniform success. Platelet rich plasma (PRP) injection has emerged as a treatment alternative for many musculoskeletal conditions. We have done the study on sixty patients to evaluate & compare the effects of platelet rich plasma & steroid injection on patients with planter fascitis. The results at the 1,3 & 6 months were evaluated,which showed the good results with platelet rich plasma in comparison to steroid injections.
Autologous blood injections for chronic plantar fasciitis ‐ a pilot case-series study shows promising results
Wheeler, Patrick
International Musculoskeletal Medicine, Volume 35, Number 1, April 2013 , pp. 3-7(5)
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Objectives
Plantar fasciitis is a common condition with a small number of people having symptoms that are challenging to treat. This prospective case series pilot study paper reports the patient outcomes following ultrasound-guided autologous blood injections (ABI) for the treatment of chronic plantar fasciitis symptoms.
Methods and patients
Prospective case-series study of 35 consecutive patients who have undergone ultrasound-guided ABI for recalcitrant plantar fasciitis symptoms in a National Health Service Sports Medicine Clinic in Leicester, UK. Patients treated had suffered with symptoms of plantar fasciitis for an average of more than 4 years pre-ABI. Patients had an average follow-up of 6 months and with a maximum of over 800 days. The outcome measures include visual analogue scale (VAS) for pain, and 7-part patient satisfaction outcome scale.
Results
There was an average reduction of VAS of more than 85% post-ABI for all enrolled patients, increasing to nearly 90% in patients with at least 2 months follow-up data. At the latest follow-up appointment 53% of all patients were pain-free following the ABI procedure, increasing to 71% of patients with at least 2 months of follow-up data.
Discussion
While causality is not proved in this study design, ultrasound-guided ABI appear to be successful in the treatment of recalcitrant plantar fasciitis. Further studies with greater methodological rigour using a control group or alternative interventions should be conducted.
Platelet Rich Plasma for plantar fasciitis
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