A study to compare the efficacy of corticosteroid therapy with platelet-rich plasma therapy in recalcitrant plantar fasciitis: A preliminary report

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Abstract

Background

Plantar fasciitis is one of the commonest, and most frustrating, foot ailments seen in a regular orthopaedic clinic. There are a number of modalities available to treat this condition, of which corticosteroid injection is, perhaps, the most popular. However, recent years have seen an increased interest in the use of platelet-rich plasma (PRP) injections in various clinical situations such as plantar fasciitis.

Methods

We undertook a prospective non-randomized study to compare the efficacy of traditional corticosteroid injection (Steroid group) to PRP injection (PRP group), in a cohort of patients.

Results

We studied both groups of patients before and after the injections using Visual Analogue Score (VAS), the Foot & Ankle Disability Index (FADI) and American Foot and Ankle Score (AFAS). Our study confirms that there is significant clinical improvement in PRP group at three months after the injection.

Conclusion

The use of PRP injection can be an attractive alternative in the treatment of disabling, recalcitrant plantar fasciitis.

Study design

Cohort study.

Level of clinical evidence

Level 3.

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.

Section snippets

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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