Plantar Fasciitis? PRP Benefits for the Long-Run

The Effects of Platelet-Rich Plasma in the Treatment of Plantar Fasciitis: A Meta-analysis of Randomized Controlled Trials.

Ling Y, Wang S. Medicine. 2018 Sept. doi: 10.1097/MD.0000000000012110.
TextFreely Available

Take Home Message: A platelet-rich plasma injection is more beneficial than steroid injections or placebo for long-term relief of pain and dysfunction associated with plantar fasciitis.  

While most cases of plantar fasciitis resolve after noninvasive treatments (heel cups, eccentric stretching, orthotics, etc), there are individuals who fail to respond to these treatments. Invasive treatment of plantar fasciitis includes local injections of steroids, although alternative treatments have emerged.  Platelet-rich plasma (PRP) injections are becoming more prominent in treatment of chronic injuries; however, the benefits for plantar fasciitis remain controversial. Therefore, the authors conducted a meta-analysis to compare the effects of PRP and other treatments in people with plantar fasciitis. Three databases were searched for randomized controlled trials comparing PRP to non-surgical interventions (i.e., steroid, whole blood, or placebo) for plantar fasciitis. The outcome measures of interest were pain and function measured by the visual analog scale (VAS), the American Orthopeadic Foot and Ankle Society Score (AOFAS), and Roles-Maudsley score. The final analysis included 10 randomized controlled trials published between 2012 and 2017 with a combined total of 445 participants (71% female). Those who received PRP, compared to the control, reported improved pain on the VAS at 12 months post-injection, whereas no differences were observed at 1, 3, or 6 months. Comparable changes between 1, 3, and 6 months were seen between PRP and steroid treatment, but differences during this time? were observed between PRP and placebo.  Similarly, patients who received PRP treatment reported increases in function (AOFAS scores) at 12-months post-injection; however, similar changes were observed at 1, 3, and 6 months compared with control treatments.

The authors demonstrated that PRP may be more effective than other aggressive treatments for long-term pain relief and improved function. While reductions in pain were similar between PRP and steroid injections in the early phases of recovery, PRP was more effective at keeping the pain reduced a year after treatment. Furthermore, PRP injections were more successful at reducing the amount of dysfunction at the one-year follow-up compared to other treatments. Clinicians treating patients with plantar fasciitis may consider a PRP injection a good option for pain relief and functional benefit.

Questions for Discussion: Have you recommended or considered PRP injections for patients with plantar fasciitis? What has been your experience with patients receiving PRP treatment for plantar fasciitis?

Written by: Danielle M. Torp

Reviewed by: Jeffrey Driban

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Injuries = Time And Money Loss. Why Not Prevent Injuries with the 11+ Kids Program?

Comparison of the ‘11+ Kids’ injury prevention programme and a regular warm-up in children’s football (soccer): a cost effectiveness analysis

Rössler R, Verhagen E, Rommers N, Dvorak J, Junge A, Lichtenstein E, Donath L, Faude O. Br J Sports Med. 2018. [Epub ahead of print]

Full Text Freely Available

Take Home Message: Participation in the 11+ Kids program resulted in ~50% lower healthcare costs compared with a usual youth soccer warm-up program.

Injuries sustained during an athlete’s youth can lead to health problems later in life (e.g., reduced physical activity, early-onset osteoarthritis). Additionally, the economic burden of these injuries is experienced individually and societally. Preventing injuries in youth sports may promote better long-term health and reduce the financial burden of an injury. However, more studies are needed to quantify the cost effectiveness of injury prevention programs for young athletes. Therefore, the authors completed an economic analysis to compare the cost-effectiveness of the 11+ Kids program with a typical warm-up routine among young soccer athletes.

Current trends in tendinopathy: consensus of the ESSKA basic science committee. Part II: treatment options

Current trends in tendinopathy: consensus of the ESSKA basic science committee. Part II: treatment options.

Abat F, Alfredson H, Cucchiarini M, Madry H, Marmotti A, Mouton C, Oliveira JM, Pereira H, Peretti GM, Spang C, Stephen J, van Bergen CJA, de Girolamo L. J Exp Orthop. 2018 Sep 24;5(1):38. doi: 10.1186/s40634-018-0145-5.

Full Text Freely Available

The European Society of Sports Traumatology, Knee Surgery, & Arthroscopy Basic Science Committee offered a consensus statement “to provide a comprehensive overview of the latest treatment options for tendinopathy”. Treatment options included platelet rich plasma, ultrasound guided galvanic electrolysis technique, mesenchymal stem cells, gene therapy, biomaterials, and surgical approaches.

View 173 other recent position statements, consensus statements, guidelines, and recommendations related to sports medicine.

EPA guidance on physical activity as a treatment for severe mental illness: a meta-review of the evidence and Position Statement from the European Psychiatric Association (EPA), supported by the International Organization of Physical Therapists in Mental Health (IOPTMH).

EPA guidance on physical activity as a treatment for severe mental illness: a meta-review of the evidence and Position Statement from the European Psychiatric Association (EPA), supported by the International Organization of Physical Therapists in Mental Health (IOPTMH).

Stubbs B, Vancampfort D, Hallgren M, Firth J, Veronese N, Solmi M, Brand S, Cordes J, Malchow B, Gerber M, Schmitt A, Correll CU, De Hert M, Gaughran F, Schneider F, Kinnafick F, Falkai P, Möller HJ, Kahl KG. Eur Psychiatry. 2018 Oct;54:124-144. doi: 10.1016/j.eurpsy.2018.07.004.

Full Text Not Freely Available

The European Psychiatric Association has released a position statement on physical activity as a treatment for severe mental illness. The goal of this review and position statement was to 1) describe the benefits of physical activity or exercise across all types of severe mental illness; 2) examine how these benefits may differ across specific types of severe mental illness; and 3) offer guidance for clinical practice, policy and future research.

View 172 other recent position statements, consensus statements, guidelines, and recommendations related to sports medicine.

Former Division III Female Collegiate Athletes Report Better Overall Long-Term Health

Female Sport Participation Effect on Long-Term Health-Related Quality of Life

Stracciolini A, Amar-Dolan L, Howell DR, Alex T, Berkner P, Sandstrom NJ, Peluso M, Kurtz M, Rebekah M, Meehan WP.  Clin J Sport Med. 2018; 00: 1-7. DOI:10.1097/JSM.0000000000000645

https://journals.lww.com/cjsportsmed/Abstract/publishahead/Female_Sport_Participation_Effect_on_Long_Term.99150.aspx

Take Home Message: Females who were former NCAA Division III athletes were more likely to report several long-term health benefits (i.e., very good/excellent overall health, healthy exercise habits, less chronic health conditions) than non-athletes.  Despite these positive benefits, the authors noted that former athletes reported poorer mobility and higher anxiety.

Sport participation is often viewed as having a positive effect on physical and psychological health; however, the long-term effects of sport participation remain largely unknown.  Furthermore, female sport participation numbers have drastically increased, and we know even less about the long-term effects of sports on females.  Hence, these researchers surveyed NCAA Division III institution alumni between 40 to 70 years of age to determine the relationship between a history of collegiate sport participation and health outcomes and quality of life.

Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

Diagnosis: History, Physical Examination, Imaging, and Arthroscopy:

Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

Christiaan J. A. van Bergen, MD, PhD, Onno L. Baur, BSc, Christopher D. Murawski, MD, Pietro Spennacchio, MD, Dominic S. Carreira, MD, Stephen R. Kearns, MD, Adam W. Mitchell, MD, Helder Pereira, MD, Christopher J. Pearce, MD, James D. F. Calder, MD, PhD,

Foot & Ankle International 39(1_suppl), July 2018; First Published July 2, 2018; pp. 3S–8S

Conservative Management and Biological Treatment Strategies:

Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

Malcolm E. Dombrowski, MD, Youichi Yasui, MD, Christopher D. Murawski, MD, Lisa A. Fortier, DVM, PhD, Eric Giza, MD, Amgad M. Haleem, MD, PhD, Kamran Hamid, MD, Rocky Tuan, PhD, Zijun Zhang, MD, PhD, Lew C. Schon, MD, MaCalus V. Hogan, MD,

Foot & Ankle International 39(1_suppl), July 2018; First Published July 2, 2018; pp. 9S–15S

Debridement, Curettage, and Bone Marrow Stimulation:

Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

Charles P. Hannon, MD, Steve Bayer, BA, Christopher D. Murawski, MD, Gian Luigi Canata, MD, Thomas O. Clanton, MD, Daniel Haverkamp, MD, PhD, Jin Woo Lee, MD, PhD, Martin J. O’Malley, MD, Hua Yinghui, MD, PhD, James W. Stone, MD,

Foot & Ankle International 39(1_suppl), July 2018; First Published July 2, 2018; pp. 16S–22S

Fixation Techniques:

Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

Mikel L. Reilingh, MD, PhD, Christopher D. Murawski, MD, Christopher W. DiGiovanni, MD, Jari Dahmen, BSc, Paulo N. F. Ferrao, MBChB (Pret), FCS (SA) Ortho, Kaj T. A. Lambers, MD, Jeffrey S. Ling, BSc(Med), MBBS, FRACS(Orth), Yasuhito Tanaka, MD, Gino M. M. J. Kerkhoffs, MD, PhD,

Foot & Ankle International 39(1_suppl), July 2018; First Published July 2, 2018; pp. 23S–27S

Osteochondral Autograft:

Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

Eoghan T. Hurley, MB, BCh, Christopher D. Murawski, MD, Jochen Paul, MD, Alberto Marangon, MD, Marcelo P. Prado, MD, Xiangyang Xu, MD, Laszlo Hangody, MD, John G. Kennedy, MD, MCh, MMSc, FRCS (Orth),

Foot & Ankle International 39(1_suppl), July 2018; First Published July 2, 2018; pp. 28S–34S

Osteochondral Allograft:

Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

Niall A. Smyth, MD, Christopher D. Murawski, MD, Samuel B. Adams, Jr, MD, Gregory C. Berlet, MD, Roberto Buda, MD, Sameh A. Labib, MD, James A. Nunley, II, MD, Steven M. Raikin, MD,

Foot & Ankle International 39(1_suppl), July 2018; First Published July 2, 2018; pp. 35S–40S

Scaffold-Based Therapies:

Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

Benjamin B. Rothrauff, MD, PhD, Christopher D. Murawski, MD, Chayanin Angthong, MD, PhD, Christoph Becher, MD, Stefan Nehrer, MD, Philipp Niemeyer, MD, Martin Sullivan, MD, Victor Valderrabano, MD, Markus Walther, MD, Richard D. Ferkel, MD,

Foot & Ankle International 39(1_suppl), July 2018; First Published July 2, 2018; pp. 41S–47S

Subchondral Pathology:

Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

Yoshiharu Shimozono, MD, Alexandra J. Brown, MS, Jorge P. Batista, MD, Christopher D. Murawski, MD, Mohamed Gomaa, MD, Siu Wah Kong, MB, BS(HKU), FRCSEd(Orth), FHKAM(Orth Surg), FHKCOS(Orth Surg), PGDip SEM(Bath), Tanawat Vaseenon, MD, Masato Takao, MD, PhD, Mark Glazebrook, MD, FRCS(C), MSc, PhD,

Foot & Ankle International 39(1_suppl), July 2018; First Published July 2, 2018; pp. 48S–53S

Revision and Salvage Management:

Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

Peter N. Mittwede, MD, PhD, Christopher D. Murawski, MD, Jakob Ackermann, MD, Simon Görtz, MD, Beat Hintermann, MD, Hak Jun Kim, MD, PhD, David B. Thordarson, MD, Francesca Vannini, MD, PhD, Alastair S. E. Younger, MBChB, ChM, FRCSC,

Foot & Ankle International 39(1_suppl), July 2018; First Published July 2, 2018; pp. 54S–60S

Rehabilitation and Return to Sports:

Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

Pieter D’Hooghe, MD, MSc, MBA, Christopher D. Murawski, MD, Lorraine A. T. Boakye, MD, David O. Osei-Hwedieh, PhD, Mark C. Drakos, MD, Jay Hertel, PhD, ATC, Keun Bae Lee, MD, PhD, Adam Popchak, DPT, PhD, SCS, Martin Wiewiorski, MD, C. Niek van Dijk, MD, PhD,

Foot & Ankle International 39(1_suppl), July 2018; First Published July 2, 2018; pp. 61S–67S

Post-treatment Follow-up, Imaging, and Outcome Scores:

Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

Pim A. D. van Dijk, BSc, Christopher D. Murawski, MD, Kenneth J. Hunt, MD, Carol L. Andrews, MD, Umile Giuseppe Longo, MD, MSc, PhD, Graham McCollum, MMed (UCT), FC Ortho (SA), MBChB (UCT), Helene Simpson, PT, Carolyn M. Sofka, MD FACR, Ichiro Yoshimura, MD, PhD, Jón Karlsson, MD, PhD,

Foot & Ankle International 39(1_suppl), July 2018; First Published July 2, 2018; pp. 68S–73S

Full Text Not Freely Available

Foot & Ankle International published a special issue to highlight the Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. These consensus statements were organized by 75 global experts in ankle cartilage repair from 25 countries and 1 territory who formed 11 working groups focusing on topics ranging from the diagnosis, treatment, rehabilitation, and follow-up of ankle cartilage injuries.

View 171 other recent position statements, consensus statements, guidelines, and recommendations related to sports medicine.

It’s not Just Walking and Texting That’s Problematic. So Is Walking While Concussed

Examining motor tasks of differing complexity after concussion in adolescents

Howell DR, Myer GD, Grooms D, Diekfuss J, Yuan W, Meehan WP. Arch Phys Med Rehabil. 2018. [Epub ahead of print]

https://www.ncbi.nlm.nih.gov/pubmed/30193950

Take Home Message: Following a concussion, athletes typically walk slower and perform poorly on cognitive tasks compared to controls. Hence, a gait task test may be a beneficial concussion assessment.

Many athletes who sustain a concussion suffer motor control deficits, specifically the inability to optimally perform dual tasks (motor and cognitive tasks). However, a challenge to assessing motor control deficits is that we often rely on self-reported balance issues to assess postural control abnormalities, which may lead to inaccuracies in diagnosis and returning an athlete to play. Therefore, the authors sought to determine if an athlete with a concussion completes motor tasks of different complexity (in isolation or when combined with a cognitive task) worse than healthy athletes. Furthermore, they aimed to determine if athletes who have self-reported balance problems following a concussion demonstrate worse gait, stance, or cognitive deficits than those who do not report balance problems.