Plantar fasciitis is a condition that can be difficult to treat. The long list of available treatments suggests that no one method can guarantee complete success. While steroid injections are known to give good short-term outcomes, they do not heal the underlying problem and the pain then often returns with time. There are also concerns over the long-term side effects of repeated steroid injections. PRP has been used for many years now in the treatment of chronic plantar fasciitis and appears to work better in the long-term than injections with corticosteroids. At the Orthobiologics Clinic we feel that PRP is an excellent way of treating plantar fasciitis when other non-operative treatment has been tried unsuccessfully.
The authors of this trial randomly treated 115 patients with chronic plantar fasciitis with a single injection of either PRP or corticosteroids. Patients were then followed up for 12 months. While patients in the corticosteroid group improved more quickly, patients in the PRP group had a better outcome after 1 year in terms of pain and function. 84% of patients in the PRP group improved by at least 25%; the corresponding figure in the corticosteroid group was only 55%. The authors concluded that treatment of patients with chronic plantar fasciitis with PRP seems to reduce pain and increase function more as compared with the effect of corticosteroid injection.
At the Orthobiologics Clinic we were encouraged by the positive outcomes of this well-designed trial demonstrating the long-term benefits of treatment with PRP.
The authors of this publication carried out a systematic review of scientific publications investigating the effect of autologous blood and PRP in the treatment of chronic plantar fasciitis. 16 publications were analysed. The authors found that corticosteroid injections provide good short-term symptom relief, but the effect then disappears at 6 months. PRP provided better pain relief at 6 months than corticosteroids. The authors concluded that that platelet-rich plasma may provide a long-term effect in relieving pain in plantar fasciopathy patients.
At the Orthobiologics Clinic we noted with interest yet another publication demonstrating the good long-term outcomes of patients treated with PRP compared to the short-lasting effect of corticosteroid injections.
The authors carried out a systematic literature review in order to determine whether platelet-rich plasma (PRP) injections are associated with improved pain and function scores when compared with corticosteroid injections for plantar fasciopathy. They identified and analysed 10 studies with 517 patients who had been diagnosed with chronic plantar fasciitis. The authors found that PRP worked better than corticosteroids at 3 months for pain. But no differences between PRP and corticosteroids were observed at 6 and 12 months. They concluded that PRP injections are associated with improved pain and function scores at three-month follow-up when compared with corticosteroid injections. They also pointed out that further, large-scale, high-quality, randomised controlled trials with blinding of outcome assessment and longer follow-up are required.
At the Orthobiologics Clinic we were slightly surprised by the findings of this publication, due to it contradicting the outcomes of other research. We absolutely agree with the authors that there is a need for more high-quality research to determine the value of PRP in the treatment of plantar fasciitis.