SLR - February 2020 - Vincent G. Vacketta
Positive Effect of Platelet-rich Plasma on Pain in Plantar Fasciitis: A Double-Blind Multicenter Randomized Controlled Trial
Reference: Peerbooms JC, Lodder P, den Oudsten BL, Doorgeest K, Schuller HM, Gosens T. Positive Effect of Platelet-Rich Plasma on Pain in Plantar Fasciitis: A Double-Blind Multicenter Randomized Controlled Trial. American Journal of Sports Medicine. 2019;47(13)
Scientific Literature Review
Reviewed By: Vincent G. Vacketta, DPM
Residency Program: West Penn Hospital – Pittsburgh, PA
Podiatric Relevance: A common condition seen by foot and ankle surgeons is plantar fasciitis (PF). This condition is commonly treated through an array of conservative treatment modalities including, but not limited to, rest, stretching protocols, physical therapy, foot orthosis, splinting, anti-inflammatory medication and extracorporeal shockwave therapy. In the acute setting, this condition is characterized primarily by inflammation making it amenable to many of the aforementioned treatments. In the chronic setting, this condition is further complicated by degeneration and fibrosis, which may be recalcitrant to standard conservative therapies. This article investigates the efficacy of platelet rich plasma (PRP) injections versus traditional corticosteroid injections in patients suffering from chronic PF.
Methods: A prospective, level I, randomized controlled trial was performed on 115 subjects with chronic PF. All subjects meeting inclusion and exclusion criteria were allocated into the PRP or corticosteroid treatment groups. Following double blind randomization and distribution, patients received treatment consisting of one injection of 5 to 6 mL PRP injection or a 5 to 6 mL injection of 40 mg/mL triamcinolone acetonide. Post-injection protocol consisted of a standardized 4-week protocol involving an initial immobilization period followed by home stretching and strengthening routines. At four weeks, patients were permitted to resume recreational activities. Anti-inflammatory medication was strictly prohibited throughout the treatment course. The primary outcome measure evaluated was the Foot Function Index (FFI) pain score. Secondary outcome measures were function and quality of life, which were measured by FFI activity and disability scores, American Orthopaedic Foot and Ankle Society scores, and the World Health Organization Quality of Life scores. All outcomes were evaluated at baseline, four, 12, 26 and 52 weeks after the procedure.
Results: Of the 115 patients, 46 subjects in the PRP group and 36 of the corticosteroid group completed the study. The corticosteroid group showed rapid initial reduction in FFI Pain scores, which remained stable during the follow-up period. In contrast, the PRP group showed a more gradual reduction in FFI Pain, which reached a greater reduction in pain scores at final follow-up. More subjects in the PRP group reached at least 25 percent improvement in the FFI Pain score when compared to the corticosteroid group. The secondary outcome measures demonstrated significantly lower FFI Disability scores in the PRP group when compared to the corticosteroid group.
Conclusions: This study suggests that treatment of patients with chronic PF using PRP may reduce pain and increase function more as compared with the effect of corticosteroid injection. When used in the appropriate patient, this treatment method can be a viable option in the vast selection of treatment options. Due to the regenerative characteristics of PRP it would appear to be most appropriate in patients suffering from chronic versus acute PF as seen in this study. Strengths of this study include a relatively large patient population with long-term follow-up. Limitations and weaknesses of this study include inconsistency in the treatment groups in regards to the PRP protocol used as well as the lack of ultrasound guidance for the administration of the injection.