Advertisement

Platelet-Rich Plasma Has Better Long-Term Results Than Corticosteroids or Placebo for Chronic Plantar Fasciitis: Randomized Control Trial

Published:November 15, 2018DOI:https://doi.org/10.1053/j.jfas.2018.07.006

      ABSTRACT

      Plantar fasciitis is the most common cause of heel pain. Platelet-rich plasma (PRP) is a supersaturated concentration of autologous platelets that augments the natural healing response of fascia. Previous studies have shown the superiority of PRP over corticosteroids (CS) for chronic plantar fasciitis. The aim of this study was to compare the pain and functional outcomes of PRP with CS and placebo injections for the treatment of chronic plantar fasciitis. We conducted a 3-arm randomized controlled trial of 90 patients: PRP (n = 30 patients), CS (n = 30 patients), and placebo (n = 30 patients). The patients were followed at regular intervals until 18 months postinjection using validated instruments. The mean visual analog scale score showed significant improvement in all groups between baseline and 18-month follow-up (PRP: 8.2 vs 2.1; CS: 8.8 vs 3.6; placebo: 8.1 vs 5.4), with CS showing significantly better improvement than PRP in the short term, whereas longer-term PRP was significantly better than CS. The mean Roles and Maudley score showed significant improvement in all groups between baseline and 18-month follow-up (PRP: 1.7 vs 3.7; CS: 1.2 vs 3.1; placebo: 1.2 vs 2.0), with CS showing significantly better improvement than PRP in the short term, whereas longer-term PRP was significantly better than CS. The mean Short Form 12 score showed significant improvement in all groups between baseline and 18-month follow-up (PRP: 55.4 vs 80.2; CS: 56.2 vs 76.2; placebo: 54.1 vs 62.4). We found that all 3 groups showed significant improvement between baseline and end of the follow-up period with regard to pain, function, and general health. The CS arm showed better improvement in the short term, whereas the PRP arm showed better results in the long term. In contrast to previous studies, we found no significant drop-off effect of CS in the long term, which may be owing to background natural healing process of the disease. In summary, both PRP and CS are safe and effective treatment options for chronic plantar fasciitis, showing superior results to placebo treatment. The longer-term results and less reinjection and/or surgery rate of PRP makes it more attractive as an injection treatment option versus CS injection.

      Level of Evidence

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Foot and Ankle Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cutts S
        • Obi N
        • Pasapula C
        • Chan W
        Plantar fasciitis.
        Ann R Coll Surg Engl. 2012; 94: 539-542
        • Riddle DL
        • Pulisic M
        • Pidcoe P
        • Johnson RE
        Risk factors for plantar fasciitis: a matched case-control study.
        J Bone Joint Surg Am. 2003; 85-A: 872-877
        • Riddle DL
        • Schappert SM
        Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors.
        Foot Ankle Int. 2004; 25: 303-310
        • LH Gill
        Plantar fasciitis: diagnosis and conservative management.
        J Am Acad Orthop Surg. 1997; 5: 109-117
        • Wapner KL
        • Sharkey PF
        The use of night splints for treatment of recalcitrant plantar fasciitis.
        Foot Ankle. 1991; 12: 135-137
        • Donley BG
        • Moore T
        • Sferra J
        • Gozdanovic J
        • Smith R
        The efficacy of oral nonsteroidal anti-inflammatory medication (NSAID) in the treatment of plantar fasciitis: a randomized, prospective, placebo-controlled study.
        Foot Ankle Int. 2007; 28: 20-23
        • Crawford F
        • Atkins D
        • Young P
        • Edwards J
        Steroid injection for heel pain: evidence of short-term effectiveness.
        A randomized controlled trial. Rheumatol Oxf Engl. 1999; 38: 974-977
        • Tsai W-C
        • Hsu C-C
        • Chen CPC
        • Chen MJL
        • Yu T-Y
        • Chen Y-J
        Plantar fasciitis treated with local steroid injection: comparison between sonographic and palpation guidance.
        J Clin Ultrasound JCU. 2006; 34: 12-16
        • Tatli YZ
        • Kapasi S
        The real risks of steroid injection for plantar fasciitis, with a review of conservative therapies.
        Curr Rev Musculoskelet Med. 2008; 2: 3-9
        • Arnoczky SP
        • Sheibani-Rad S
        • Shebani-Rad S
        The basic science of platelet-rich plasma (PRP): what clinicians need to know.
        Sports Med Arthrosc Rev. 2013; 21: 180-185
        • Foster TE
        • Puskas BL
        • Mandelbaum BR
        • Gerhardt MB
        • Rodeo SA
        Platelet-rich plasma: from basic science to clinical applications.
        Am J Sports Med. 2009; 37: 2259-2272
        • Hall MP
        • Band PA
        • Meislin RJ
        • Jazrawi LM
        • Cardone DA
        Platelet-rich plasma: current concepts and application in sports medicine.
        J Am Acad Orthop Surg. 2009; 17: 602-608
        • Wessel J
        The reliability and validity of pain threshold measurements in osteoarthritis of the knee.
        Scand J Rheumatol. 1995; 24: 238-242
        • Roles NC
        • Maudsley RH
        Radial tunnel syndrome: resistant tennis elbow as a nerve entrapment.
        J Bone Joint Surg Br. 1972; 54: 499-508
        • Ware J
        • Kosinski M
        • Keller SD
        A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity.
        Med Care. 1996; 34: 220-233
        • 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
        • Akşahin E
        • Doğruyol D
        • Yüksel HY
        • Hapa O
        • Doğan O
        • Celebi L
        • et al.
        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
        • Kalaci A
        • Cakici H
        • Hapa O
        • Yanat AN
        • Dogramaci Y
        • Sevinç TT
        Treatment of plantar fasciitis using four different local injection modalities: a randomized prospective clinical trial.
        J Am Podiatr Med Assoc. 2009; 99: 108-113
        • 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
        • López-Gavito E
        • Gómez-Carlín LA
        • Parra-Téllez P
        • Vázquez-Escamilla J
        [Platelet-rich plasma for managing calcaneus tendon tendinopathy and plantar fasciitis].
        Acta Ortopédica Mex. 2011; 25: 380-385
        • Ragab EMS
        • Othman AMA
        Platelets rich plasma for treatment of chronic plantar fasciitis.
        Arch Orthop Trauma Surg. 2012; 132: 1065-1070
        • O'Malley MJ
        • Vosseller JT
        • Gu Y
        Successful use of platelet-rich plasma for chronic plantar fasciitis.
        HSS J. 2013; 9: 129-133
        • Kim E
        • Lee JH
        Autologous platelet-rich plasma versus dextrose prolotherapy for the treatment of chronic recalcitrant plantar fasciitis.
        PM R. 2014; 6: 152-158