Platelet-Rich Plasma Has Better Long-Term Results Than Corticosteroids or Placebo for Chronic Plantar Fasciitis: Randomized Control Trial.
Shetty SH, Dhond A, Arora M, Deore S. J Foot Ankle Surg. 2018. [Epub ahead of print]
Take Home Message: Patients with plantar fasciitis that received platelet-rich plasma (PRP) injections had better long-term outcomes compared to a placebo or corticosteroid injection.
Plantar fasciitis is a common cause of heel pain. About 90% of cases resolve with conservative treatment within a few weeks. However, there is no consensus on best practices and very few investigators have conducted randomized control trials to assess the efficacy between different therapeutic options. Therefore, the authors conducted a randomized control trial to investigate the efficacy of platelet-rich plasma (PRP) injections compared to corticosteroid or placebo injections among people with chronic plantar fasciitis. Ninety patients (30 patients per group; 54% female, ~45 years of age, ~7 months of symptoms) were randomized into PRP (2ml PRP with 1ml 1% lidocaine), corticosteroid (2ml methylpredinsone acetonide with 1ml 1% lidocaine), or control group (2ml .9% saline with 1ml 1% lidocaine). Participants reported their pain (0-10 scale), general health (Short Form (SF)-12 scores), and function (Roles and Maudsley scores) at pre-injection, 1-week, 3-weeks, and 3-, 6-, 12-, and 18-months post injection. Participants that received corticosteroid injections reported greater improvements in pain, general health, and function in the first 3 weeks; however, participants that received PRP demonstrated the greatest improvement from 3 to 18 months post injection in all 3 outcome measures. The authors noted no complications; however, more participants that received a corticosteroid injection needed repeat injections or opted for surgical intervention.
This is an interesting study as it uses multiple outcome measures to assess pain, function, and general health following an injection for plantar fasciitis. This clinical trial supports a recent meta-analysis we reported on where the authors found that PRP offered better long-term outcomes than corticosteroids or placebo injections. The current authors also found that a corticosteroid injection had better short-term outcomes compared to PRP. This suggests that the active ingredients act differently to alleviate pain and improve function. It would be interesting to identify if PRP improves the underlying pathophysiology such as angiogenesis (growth of new blood vessels). Currently, medical professionals should understand the differences between different injection therapies and discuss the advantages and disadvantages with patients.
Questions for Discussion: How many of your patients received injections for plantar fasciitis? Would you consider suggesting PRP treatment for your patients?