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.
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