A study to compare the efficacy of corticosteroid therapy with platelet-rich plasma therapy in recalcitrant plantar fasciitis: A preliminary report
Introduction
Plantar fasciitis (PF), both acute and chronic, is one of the commonest foot ailments [1]. More than two million individuals are treated for chronic PF on an annual basis, in the United Sates alone, accounting for 11 to 15% of visits related to foot ailments [2].
PF is considered a self-limiting condition. However, it may require a resolution time ranging from 6 to18 months and sometimes even longer which can lead to frustration on both, the physician and the patient [3], [4]. There are many treatment modalities available for PF, both medical and surgical, with variable success rates.
The primary treatment for PF is rest and avoidance of aggravating activity; this provides significant pain relief. According to Wolgin et al. [5], rest was the treatment that worked best for 25% of PF patients whereas a pair of proper shoes or change of footwear was considered by 14% of PF patients as the treatment that worked best [6]. Strapping, taping or accommodative heel cups and orthotics may be effective components of a PF treatment plan [7]. Other treatment options include stretching and strengthening exercises, night splinting and walking cast [5], [8], [9].
Traditionally, if conservative treatment for chronic plantar fasciitis failed, corticosteroids were administered which provided temporary pain relief [9], [10]. However, recurrences after steroid injections are well known. This has led to the use of other, safe, injection forms such as PRP. The logic is that PRP enhances local healing thereby improved clinical outcome [11]. This is a preliminary report of a study to compare the efficacy of corticosteroid injection to PRP injection in PF. To our knowledge, this is the first study comparing the efficacy of two forms of injections in the treatment of difficult clinical scenario of PF.
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Patients and methods
This study was commenced after obtaining approval from the Institutional Ethics Committee. Plantar fasciitis (PF) was defined as pain over the medial part of the foot at the origin of plantar fascia and over its course; with pain on direct palpation and on forced dorsiflexion. All individuals with recalcitrant PF visiting our institution from July 2010 were evaluated. Patients were divided into two groups; those receiving corticosteroid (steroid group) and those receiving PRP (PRP group). It
Results
The age and sex distribution of the subjects of this study are shown in Table 1. As shown in Table 2 there is highly significant difference in both groups for all post-operative outcome measures (VAS, AFAS and FADI), with much better improvement in the PRP group as compared to the Steroid group (Fig. 2A and B).
Discussion
Plantar fasciitis (PF) is a common clinical problem with many available treatment modalities. Traditional treatment for PF includes rest, analgesics and stretching exercises. Injections, particularly corticosteroids, are given in very acute situations and for cases unresponsive to conservative methods. Corticosteroids offer a quick fix for pain relief in the acute phase but have limited effect in chronic cases with a significant fraction of patients suffering from relapse and recurrence [6], [8]
Conclusion
We believe that PRP injection is safe and can be an excellent alternative to corticosteroid injection in plantar fasciitis, not responsive to conservative means. The findings of this preliminary study can be very relevant in clinical practice. However, these findings should be taken in context to the limitations of the study.
Conflict of interest statement
All the authors declare that there are no conflicts of interest regarding this article and no source of funding has been received.
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Comparative study of local injections of autologous platelet rich plasma versus corticosteroid in management of chronic plantar fasciitis
2023, Journal of Clinical Orthopaedics and TraumaComparison of midterm results of Platelet Rich Plasma (PRP) versus Steroid for plantar fasciitis: A randomized control trial of 118 patients
2021, Journal of Clinical Orthopaedics and TraumaCitation Excerpt :In the study of Shetty et al., the authors compared the efficacy of corticosteroid injection (30 patients) with PRP injection (30 patients). At the 3-month of follow-up, the postoperative measure outcomes were significantly improved in both groups.32 And these results were much better in the PRP group than that in the steroid group.32
Platelet-Rich Plasma
2019, Clinics in Sports MedicineThickness of plantar fascia is not predictive of functional outcome in plantar fasciitis treatment
2018, Acta Orthopaedica et Traumatologica TurcicaCitation Excerpt :Thus, we believe our study is more representative of general population. Following treatment with ESWT or corticosteroid injections, plantar fasciitis symptoms usually regress and patients tend to have functional recovery.13,17–22 In our study, patients in both groups had significantly higher AOFAS scores at week 6 compared to baseline values.
Platelet-Rich Plasma Versus Corticosteroids in the Treatment of Chronic Plantar Fasciitis: A Systematic Review and Meta-analysis of Prospective Comparative Studies
2020, Journal of Foot and Ankle SurgeryCitation Excerpt :The preparations for the PRP and corticosteroid injections varied among studies. Regarding corticosteroids, dexamethasone was used in in 1 study (32), betamethasone in 1 study (33), triamcinolone in 3 studies (34–36), and methylprednisolone in 9 studies (37–45). In the study by Omar et al (46), the type of corticosteroid injection was not reported.