SLR - June 2023 - Ahmed Dabaja, DPM PGY-1
Title: Comparison of Platelet-Rich Plasma Treatment and Partial Plantar Fasciotomy Surgery in Patients with Chronic Plantar Fasciitis: A Randomized, Prospective StudyReference: Atzmon R, Eilig D, Dubin J, Vidra M, Marom O, Tavdi A, Drexler M, Palmanovich E. Comparison of Platelet-Rich Plasma Treatment and Partial Plantar Fasciotomy Surgery in Patients with Chronic Plantar Fasciitis: A Randomized, Prospective Study. J Clin Med. 2022 Nov 26;11(23):6986. doi: 10.3390/jcm11236986. PMID: 36498561; PMCID: PMC9739448.
Level of Evidence: Level II
Scientific Literature Review
Reviewed By: Ahmed Dabaja, DPM PGY-1
Residency Program: Ascension St. John Hospital, Detroit, MI
Podiatric Relevance: Podiatrists advocate all conservative treatment methods for lower extremity conditions prior to surgical options for patients. This study indicates Platelet-Rich Plasma injection as a successful alternative to surgical options and steroid injections for chronic plantar fasciitis. The authors proposed that PRP injection for chronic plantar fasciitis has potential for shorter recovery times, reduced complications, and similar activity scores. They hypothesized that PRP treatment would have comparable functional outcomes and pain levels compared to Partial Plantar Fasciotomy for recurrent chronic plantar fasciitis.
Methods: This randomized prospective cohort study from January 2015- January 2017. Two groups of sixteen participants with each group representing one treatment modality for chronic plantar fasciitis. Procedures were performed by a single foot and ankle fellowship trained surgeon. The visual analog scale (VAS), a continuous measurement for acute and chronic pain from 0-10, and the Roles-Maudsley Scale, a 4-point assessment for pain and activity limitations, 1=excellent to 4=poor post-treatment results, were used for subjective pre- and post-treatment analysis. Inclusion criteria consisted of diagnosis with clinical findings and ultrasound for recurrent CPF following conservative treatment. Conservative methods included stretching, strengthening, orthotics, chiropractic therapy, and acupuncture for at least 3 months. Exclusion criteria consisted of previous treatment with PRP injection for CPF, previous ankle or foot surgery, local steroids injection within the last six months, or existing foot pathologies such as fractures, arthritis, or bursitis. The PRP injection was performed via ultrasound guidance at the plantar fascia insertion at the anterior-medial heel. For the PPF procedure, the medial plantar fascia bands were resected through a 3 cm incision at the medial heel distal to the insertion site. All patients were evaluated in the outpatient clinic at two weeks, three months, six months, and 1-year postoperatively.
Results: Total of 36 patients randomized into two groups of Partial Plantar Fasciotomy treatment and Platelet Rich-Plasma injection treatment. The mean age of the PPF group was 47.1 (±14.4) years and 54.7 (±14.4) years for the PRP group. Average days from the patient’s first clinic visit was the same, 23.0 days. Patient pain levels and function were assessed using Visual Analog Score and Roles-Maudsley Scale respectively. Both groups portrayed reduced pain 3 months post-procedure. The RM score favored the PRP group at -1.69 vs. -0.28. The PRP group showed an improvement in activity scores from 3.0 to 2.72. The PRP group also displayed quicker recovery times on average, in response to physical therapy, 10.2 months compared to the PPF group at 37.2 months.
Conclusions: This study indicates that Platelet-Rich Plasma is a safe and effective treatment modality for patients suffering from chronic plantar fasciitis in comparison with Partial Plantar Fasciotomy as a surgical option. Results of this study demonstrate that PRP offered comparable pain reduction and improvement in function to surgical intervention, with less potential complications. Limitations of this study are its small cohort of patients and its one-year follow-up analysis. Future studies could consider analyzing different types of PRP to determine varying effectiveness in treating chronic plantar fasciitis in larger patient groups.