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
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Article info
Publication history
Published online: November 15, 2018
Footnotes
Financial Disclosure: None reported.
Conflict of Interest:None reported.
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© 2018 by the American College of Foot and Ankle Surgeons. All rights reserved.
