Role of Platelet Rich Plasma in Chronic Plantar Fasciitis: A Prospective Study

Endoscopic Treatment of Chronic Plantar Fasciitis with Plantar Heel Spur Pain: A Combined Suprafascial and Infrafascial Approach

BACKGROUND

To determine whether a combined endoscopic suprafascial and infrafascial approach with medial and lateral portals is a safe and effective technique for the endoscopic treatment of chronic plantar fasciitis with plantar heel spur pain.

METHODS

An interventional, prospective study was conducted. A total of 61 patients with plantar fasciitis with plantar heel spur pain underwent an endoscopic plantar fasciotomy with plantar heel spur resection, using a combined suprafascial and infrafascial approach between January 2018 and August 2022. Preoperative Foot and Ankle Ability Measure (FAAM), 36-Item Short Form Health Survey (SF-36), and visual analog scale (VAS) scores were measured. The measurements were repeated at 6 weeks, 3, 6, and 12 months postoperatively and at the final follow up. Preoperative and 1-year postoperative film parameters (Meary angle, calcaneal pitch angle, medial cuneiform-fifth metatarsal height) were compared.Complications were recorded at each encounter.

RESULTS

The mean follow up time was 2.6 ± 1.1 years. At the 6-week postoperative visit, the mean change in FAAM-ADL, FAAM-Sport, SF-36 physical component summary, SF-36 mental component summary, and VAS were 26.0,19.0, 44.8, 61.2, and -5.8, respectively. These changes were statistically significant (P < .001). These findings were sustained and generally improved at all other follow-up points: 3, 6, and 12 months postoperatively and final follow-up. The average period until the recovery of activities of daily living and sport activities were 2.6 and 8.6 weeks, respectively. There were no significant differences between the pre- and 1-year postoperative radiographic values (P > .05). No cases resulted in medial arch collapse. Five cases (8%) had an injury to the first branch of lateral plantar nerve.

CONCLUSION

Endoscopic plantar fascia release and plantar heel spur resection using a combined suprafascial and infrafascial approach resulted in the improvement of postoperative FAAM, SF-36, and VAS scores and involved a low incidence of postoperative complications.

Efficacy of platelet-rich plasma versus corticosteroid injections in recovery from plantar fasciitis: A systematic review and meta-analysis

Introduction

Chronic plantar fasciitis (CPF) is a degenerative condition causing persistent heel pain, making clinical management challenging. Among treatment options, the comparative effectiveness of platelet-rich plasma (PRP) and corticosteroid injections (CSIs) remains unclear. This systematic review and meta-analysis evaluate their impact on pain relief and functional improvement.

Methods

Following PRISMA guidelines, this review analyzed eight studies involving 599 participants. Pain and function were assessed using the Visual Analog Scale (VAS) and the American Orthopaedic Foot & Ankle Society (AOFAS) score. Study quality was evaluated using the Risk of Bias 2 tool, and both common- and random-effects models were applied.

Results

Pain relief results were mixed. The common-effects model favored PRP (MD = -0.7166), but the random-effects model showed no significant difference (MD = 0.4657). For functional improvement, both models indicated PRP as superior (AOFAS score: MD = 16.13, 95% CI [14.70, 17.55]), with moderate variability (I² = 48.7%).

Conclusions

PRP shows promise in improving function and potentially providing better pain relief compared to CSIs for CPF. While study variability requires careful interpretation, PRP's functional benefits support its potential as a valuable treatment. Further research with standardized protocols and diverse populations is needed to confirm its clinical effectiveness.

Ultrasonography-Guided Dextrose Prolotherapy Versus Platelet-Rich Plasma Injections for the Treatment of Plantar Fasciitis: A Randomized Controlled Trial

INTRODUCTION

Heel pain is prevalent in foot and ankle practice, with plantar fasciitis being a common cause of chronic heel pain in adults. It is a degenerative condition of the plantar fascia, rendering the term fasciitis inaccurate. The condition has several alternative names, including painful heel syndrome and heel spur syndrome. It is found that a significant number of people suffer from plantar fasciitis at some stage of their lives; athletes and women between 40 and 60 years and adults aged more than 65 suffer the most. Patients typically report tenderness at the medial aspect of the heel, and pain is mostly under the surface of the heel, especially with initial morning steps. Plantar fasciitis is predominantly unilateral. Treatment options include prolotherapy and platelet-rich plasma (PRP), with this randomized controlled trial (RCT) aiming to evaluate the efficacy of PRP versus 25% dextrose prolotherapy in alleviating plantar fasciitis symptoms.

AIMS AND OBJECTIVES

This study aimed to assess the comparative effectiveness of USG-guided 25% dextrose prolotherapy and autologous PRP injections on pain intensity, foot function, and ankle outcomes in plantar fasciitis cases.

METHODOLOGY

The study took place at the Department of Physical Medicine and Rehabilitation (PMR), King George's Medical University (KGMU), Lucknow, Uttar Pradesh, India, with eligible patients evaluated. Group A received 25% dextrose prolotherapy, while Group B was administered autologous platelet-rich plasma. Outcome measures, including pain by Pain Intensity Scale (PIS) and assessment of disability by Foot Function Index (FFI) and Foot and Ankle Outcome Score (FAOS), were assessed at baseline and the third and sixth weeks after intervention.

RESULTS

A total of 44 patients were randomized into two groups of 22. Group A received dextrose prolotherapy, while Group B was treated with PRP injections as per the study protocol. The average age of participants in our study was 36.10±10.0 years. Female participants were more affected than male participants in both groups. Overall, the male-female ratio was 38.6:61.4, while in Group A and Group B, this ratio was 45.5:54.5 and 31.8:68.2, respectively. The presentation of plantar fasciitis was bilateral (40.9%), on the right side (40.9%), and on the left side (18.2%). The right side was more frequently involved than the left side of the plantar fascia. There was a decrease in the average PIS score of Groups A and B at the baseline, which was 7.27±1.24 and 7.55±1.26, respectively, which was reduced to 3.18±1.30 and 2.50±0.67 after six weeks of follow-up. The average FFI score of Groups A and B at the baseline was 98.64±17.68 and 95.36±19.01, respectively, which was reduced to 79.77±12.77 and 63.77±18.50 after six weeks of follow-up. The average FAOS score of Groups A and B at the baseline was 71.36±13.95 and 74.86±28.72, respectively, which was reduced to 74.86±28.72 and 42.09±5.03 after six weeks of follow-up.

CONCLUSION

Both 25% dextrose prolotherapy and PRP injections are effective treatments for plantar fasciitis. Both are minimally invasive and safe treatments for plantar fasciitis.

Platelet-rich plasma for de Quervain’s tenosynovitis: A systematic review and meta-analysis

BACKGROUND

Platelet-rich plasma (PRP) injection is used as an alternative non-operative management for de Quervain’s tenosynovitis (DQT) to regenerate tendon healing.

AIM

To assess and conclude the research-based study systematically to analyse the efficacy of PRP on DQT.

METHODS

This systematic review used the Cochrane Handbook for Systematic Reviews and the guideline of preferred reporting items for systematic review and meta-analysis. A systematic literature search was applied to 11 databases. The authors assessed the study quality and risk of bias of each included study. Results of the meta-analysis were presented using mean difference (MD)/standardized mean difference (SMD) and 95% confidence interval (CI).

RESULTS

The authors evaluated 275 studies found in the literature search; 12 studies met the criteria for this review, and then the study quality and risk of bias were assessed. Pooled analysis of data from two studies involving 194 subjects with DQT showed that, compared with conservative treatment, PRP injection was associated with a greater reduction in visual analog scale pain in one month and six months after treatment (MD: -0.67, P value < 0.00001; MD: -1.16, P value < 0.00001) and the increase of Mayo’s wrist score in one month and six months after treatment (SMD: 3.72, P value < 0.00001; SMD: 4.44, P value < 0.00001).

CONCLUSION

PRP can be used as an alternative non-operative treatment for DQT due to the tissue regenerative effect of PRP.

Lateral plantar fasciopathy: An frequently overlooked cause of atraumatic pain at the fifth metatarsal base

BACKGROUND

Lateral cord plantar fasciitis (LCPF) causes atraumatic pain at the fifth metatarsal base. This study assesses the outcomes of a conservative treatment (PRP + casting) on LCPF.

METHODS

Medical history, clinical diagnosis, and ultrasound imaging were used to determine LPCF. All patients received a leucocyte-poor PRP injection at the proximal part of the fifth metatarsal base, followed by three weeks in a walking cast. Follow-up questionnaires, encompassing NRS, AOFAS, and Foot Functioning Index (FFI), were administered at 6 weeks, 12 weeks, and 2 years post-treatment.

RESULTS

Ten patients were enrolled in the study. Ultrasound findings revealed hyposonant and thickened lateral fascia plantaris at the MT 5 insertion point with normal peronei tendons. There was a notable reduction in pain from pre-treatment (NRSrest 55.1 ± 29.6, NRSactivity 79.20 ± 15.5) to 6 weeks post-treatment (NRSrest: 22.4 ± 23.6, p = 0.03; NRSactivity: 38.6 ± 30.3, p = 0.005). FFI indicated an improvement between 12 weeks (25.7 ± 25.7) and 2 years (9.1 ± 8.5) compared to pre-treatment (42.6 ± 16.7).

CONCLUSION

Ultrasound stands out as the preferred diagnostic method for identifying LCPF. A PRP injection followed by a walking cast proves effective in relieving LCPF symptoms within six weeks with sustained relief up to two years.

LEVEL OF EVIDENCE

Level IV.

Recent advances in platelet-rich plasma and its derivatives: therapeutic agents for tissue engineering and regenerative medicine

Platelet rich plasma (PRP) is a suspension of bioactive factors and chemokine enriched plasma. Platelets are a distinctive source of membrane bound and soluble proteins that are released upon their activation. The higher count of platelets renders PRP with an array of tissue regenerative abilities. PRP can be employed in the form of platelet containing plasma, platelet lysate plasma, or in the form of a pre-gelled fibrin matrix. PRP has been an essential alternative source of growth factors in the healing and regeneration of various tissues, such as musculoskeletal, cardiovascular, and dermal tissue, with additional applications in other tissues, such as hepatic and neural. A wide range of preparative and isolation strategies have been developed for various forms of PRP at laboratory and commercial scales. Concomitantly, PRP has found its applicability as an active component in several tissue regenerative approaches, including 3D printed/bioprinted constructs, injectable hydrogels, and crosslinked scaffolds. This review focuses on the various forms of PRP and their preparation methods, the latest tissue engineering applications of PRP, and the various tissue-specific clinical trials and findings conducted using PRP. We have further discussed the optimizations required in the methods of preparation, delivery, and long-term storage of PRP. Therefore, this review seeks to benefit the scope of research on PRP-based therapeutic agents in tissue engineering by providing comprehensive insights into the widespread application. We envisage PRP could be instrumental in future patient-specific tissue engineering applications in both pre-clinical and clinical settings.

New Infiltration Technique in the Treatment of the Plantar Fascia Syndrome Based on Platelet-Rich Plasma

Pain in the attachment of the plantar fascia in the calcaneus represents 10% of all sports injuries, affects 10% of foot runners, and will affect around 20% of the world population. There is no effective conservative treatment for it. This paper justifies a new definition and name for this pathology, Plantar Fascia Syndrome (PFS), presents a methodology for its diagnosis, and presents the clinical and functional effectiveness of a new conservative treatment based on platelet-rich plasma (PRP). In total, 25 patients (from an initial sample of 260) diagnosed with recalcitrant PFS lasting for more than 12 months were treated with a single infiltration of 2 mL of PRP, according to a new technic proposed. The study was approved by the ethical committee for clinical research of the reference hospital. The patients were controlled after 15, 30, 90, and 180 days, reviewing on each occasion pain, thickness of the plantar fascia, and active extension of the ankle joint. A total of 15 days after infiltration, 85% of patients had no clinical signs requiring treatment. After 90 days of infiltration, no patients showed clinical signs. This improvement in the patients' condition lasted for 180 days. All patients after treatment can fully resume normal activity with no pain.

Effect of platelet-rich plasma versus steroid injection in plantar fasciitis: a randomized clinical trial

BACKGROUND

Plantar fasciitis (PF) is a common orthopaedic problem, with heel pain worsening the quality of life. Although steroid injection is often used if the conservative treatment fails, Platelet-Rich Plasma (PRP) injection is gaining popularity due to its safety and long-lasting effect. However, the effect of PRP versus steroid injection in PF has not been studied yet in Nepal. Therefore, this study aimed to assess the effect of PRP compared with steroid injection in the treatment of PF.

METHODS

This study was a single-center, hospital-based, open-label, parallel-group randomized clinical trial to compare the effect of PRP injection with steroid injection in plantar fasciitis between August 2020 and March 2022. A total of 90 randomly selected participants aged 18 to 60 years suffering from plantar fasciitis with failed conservative treatment were intervened. The American Orthopaedic Foot and Ankle Society (AOFAS) and the Visual Analog Scale (VAS) scoring system were used to evaluate functional mobility and pain before and after the intervention for three and six months, respectively. Statistical analyses were performed using a Student's two-sample t-test. P-value < 0.05 was considered statistically significant.

RESULTS

The PRP injection showed a better outcome than the steroid injection in six months follow-up. The mean (± SD) VAS score was significantly decreased in the PRP group (1.97 + 1.13) than in the steroid group (2.71 ± 0.94) with the group difference of -0.73 (95% CI: -1.18 to -0.28) at six months. Similarly, there was a significant increase in the AOFAS scores in the PRP group (86.04 ± 7.45) compared to the steroid group (81.23 ± 9.60) at six months of follow-up with a group difference of 4.80 (95% CI: 1.15 to 8.45). There was also a significant reduction of plantar fascia thickness in the PRP group compared to that of the steroid group (3.53 ± 0.81 versus 4.58 ± 1.02) at six months of follow-up with the group difference of -1.04 (95% CI: -1.44 to -0.65).

CONCLUSION

The PRP injection showed better outcomes than steroid injection in plantar fasciitis treatment over the course of six months. Further research with a larger population and longer follow-up than six months is needed to generalize the findings and their long-term efficacy.

TRIAL REGISTRATION

NCT04985396. First registered on 02 August 2021. ( https://clinicaltrials.gov/ct2/show/NCT04985396 ).

Extracorporeal Shockwave Therapy Versus Platelet Rich Plasma Injection in Patients of Chronic Plantar Fasciitis: A Randomized Controlled Trial From a Tertiary Center of Eastern India

Introduction Plantar fasciitis is a degenerative condition of the plantar fascia that leads to heel and sole pain. Physical modalities, physiotherapy, medication, and orthoses have been tried before as treatments. Extracorporeal shockwave therapy (ESWT) and the injection of autologous platelet-rich plasma (PRP) are generally effective in the treatment of plantar fasciitis, which might be resistant to other conservative measures. The present study compares the efficacy of ESWT and PRP injection in respect of symptomatic relief, functional improvement, and change in plantar fascia thickness (PFT). Methods Seventy-two patients were enrolled and randomized into two groups. Patients in the first group received ESWT, whereas patients in the second group received PRP injections. Patients were evaluated using the Visual Analog Scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) score, along with PFT measurement (using ultrasonography) before the treatment and at days 15, 30, and 90 after the treatment. The X² test was used to compare qualitative variables, and the paired T-test was used to evaluate quantitative data. Quantitative variables had a normal distribution with a standard deviation, and the significance level was set at P-value=0.05. Results On day 0, the mean VAS of the ESWT and PRP groups were 6.44±1.11 and 6.78±1.17, respectively (p=0.237). On day 15, the mean VAS of the ESWT and PRP groups were 4.67±1.45 and 6.67±1.35, respectively (p<0.001). At day 30, the mean VAS of the ESWT and PRP groups were 4.97±1.46 and 4.69±1.39, respectively (p=0.391). On day 90, the mean VAS of the ESWT and PRP groups were 5.47±1.63 and 3.36±0.96 (p<0.001). On day 0, the mean PFTs of the ESWT and PRP groups were 4.73±0.40 and 5.19±0.51, respectively (p<0.001). At day 15, the mean PFT of the ESWT and PRP groups were 4.64±0.46 and 5.11±0.62, respectively (p<0.001) which changed to 4.52±0.53 and 4.40±0.58 at day 30 (p<0.001), and to 4.40±0.50 and 3.82±0.45 at day 90 (p<0.001). The mean AOFAS of the ESWT and PRP groups were 68.39±5.88 and 64.86±8.95 on day 0 (p=0.115), 72.58±6.26 and 67.22±10.47 on day 15 (p=0.115), 73.22±6.92 and 74.72±7.52 on day 30 (p=0.276), and 72.75±7.90 and 81.08±6.01 on day 90, respectively (p<0.001). Conclusion Both PRP injection and ESWT are very effective methods to improve pain and cause reduced plantar fascia thickness in patients with chronic plantar fasciitis non-responsive to other conservative measures. PRP injection is more effective at a longer duration as compared to ESWT.

Platelet-Rich Plasma vs Autologous Blood Injection to Treat Plantar Fasciitis: A Prospective Randomized, Double-Blinded, Controlled Trial

BACKGROUND

Plantar fasciitis (PF) is the most common cause of heel pain. Previous work has shown promising results regarding platelet-rich plasma (PRP) injections for the treatment of PF. The aim of this study is to prospectively compare the efficacy of PRP and autologous blood injections in a randomized anonymized patient group to treat PF.

METHODS

PF patients who failed at least 6 weeks of noninvasive conservative treatment aged between 40 and 65 years were recruited to be in the study. Patients were randomly assigned into group A (PRP) or group B (autologous blood). Injections were performed under ultrasonographic guidance in a double-anonymized manner. The groups were compared according to preinjection and postinjection health-related quality of life (HRQoL) scores measured with Foot and Ankle Disability Index (FADI) and visual analog scale (VAS). Intragroup comparative analysis was also performed at different time points. Independent t tests and repeated measures analyses of variance were used for statistical analysis, with P <.05 set for statistical significance.

RESULTS

Group A (PRP) included 30 (19 female, 11 male) patients with mean age 52.2 ±6.3; group B (ABI) included 30 (20 female, 10 male) patients with mean age 52.7 ± 6.5. Both groups had similar body mass index (P = .719). No injection-related complications were recorded. After treatment, both groups had improved FADI and VAS scores compared to the baseline. Although the mean HRQoL scores were higher in the PRP group, there was no significant difference between the 2 groups (P_VAS = .589; P_FADI = .742).

CONCLUSION

Participants with plantar fasciitis improved statistically significantly after either PRP or ABI injections compared with baseline HRQoL scores, with no significant differences seen between the groups.

LEVEL OF EVIDENCE

Level I, prospective randomized double-anonymized clinical comparative study.