SLR - October 2020 - Angelica C. Emeakoroha
Platelet-Rich Plasma Versus Corticosteroids for Plantar Fasciitis: A Systematic Review of Randomized Controlled Trials
Reference: Hurley E, Shimozono Y, Hannon C, Smyth N, Murawski C, Kennedy J. Platelet-Rich Plasma Versus Corticosteroids for Plantar Fasciitis: A Systematic Review of Randomized Controlled Trials. Orthop J Sports Med. 2020 Apr; 8
Scientific Literature Review
Reviewed By: Angelica C. Emeakoroha, DPM
Residency Program: St. Joseph Medical Center – Houston, TX
Podiatric Relevance: Plantar fasciitis is the most common cause of plantar heel pain and can oftentimes be very debilitating. Throughout our careers as podiatric physicians, we will encounter patients that suffer from this chronic inflammatory disease. There are different non-surgical treatment options for plantar fasciitis such as rest, stretching, insoles, non-steroidal anti-inflammatories, shockwave therapy, and injection with a corticosteroid or platelet rich plasma. In patients who don't respond to the more conservative treatment modalities, injection therapy is often utilized before considering a surgical treatment option. Traditionally, corticosteroids were the main form of injection therapy due to its anti-inflammatory properties, but it does come with risks of plantar fascia rupture and fat pad atrophy, and has been shown to not be effective long term. In recent years, physicians have started to use platelet rich plasma injections due to its strong anti-inflammatory properties with less complications and known efficacious use for other degenerative conditions. The authors conducted a systematic review of the literature involving platelet rich plasma (PRP) injections and corticosteroid (CS) injections to determine whether PRP or CS results in decreased pain levels and improved patient outcomes in plantar fasciitis.
Methods: Inclusion criteria consisted of RCTs, comparison of PRP and CS, equivalent baseline outcome measures, published in a peer-reviewed journal, published in English, and full text availability. The exclusion criteria included non-randomized studies, retrospective studies, studies that did not directly compare PRP with CS, nonclinical studies, review studies, and studies with no full text available or not published in English. The VAS and AOFAS scores were used as outcome measures and outcome measures were reported at 1, 1.5, 3, 6 and 12 months.
Results: Out of the 278 initially identified studies, only nine studies were included in this meta-analysis. The findings in this meta-analysis found that methylprednisolone was most commonly used in the CS injection. There was a statistically significant difference in the VAS scores in favor of PRP injections at all time points. There was no statistically significant difference in AOFAS scores in the two treatment groups at one and three months. At six and 12 months, there was a statistically significant difference in AOFAS scores in favor of PRP. There were no reported complications with either PRP or CS injections in any of the included nine studies.
Conclusions: In this systematic review, the authors were able to demonstrate that the short-term functional outcomes were similar for both treatment groups. Long term, the group treated with PRP had higher functional outcome scores. The authors believe that the improved functional outcomes may be due to a combination of the anti-inflammatory properties and regenerative effects of PRP. Limitations in this study include a short follow up time, difference in the PRP preparation methods, lack of reporting of PRP composition, and lack of a placebo control group. Based on this study, PRP injections seem like an effective and superior treatment modality for plantar fasciitis. However, there needs to be further studies that investigate long term data on PRP in treating plantar fasciitis.