Platelet Rich Plasma for plantar fasciitis

NewsBot · Sep 6, 2020

Prospective Randomized Evaluation of Local Injection of Allogeneic Growth Factors in Plantar Fasciitis
Mahmoud Ibrahim Kandil, MD, Eslam Abdelshafi Tabl, MD, Adel Samy Elhammady, MD
Foot & Ankle International August 5, 2020

Background:
The aim of this study was to evaluate the efficacy and safety of injection of allogeneic growth factors in patients with plantar fasciitis.

Methods:
This study included 150 patients who were randomly divided into 2 equal groups; the patients were locally injected with allogeneic growth factors (GFs) (treatment group) or with saline 0.9% (control group). The patients were assessed using visual analog scale (VAS) and Foot Function Index–Revised short form (FFI-Rs) scores preinjection and 1, 3, 6, and 12 months postinjection. The patients were questioned about their satisfaction. Any adverse effects were recorded.

Results:
At baseline, there was no significant difference between both groups regarding the mean VAS and FFI-Rs scores. At 3-month follow-up, the reduction in mean VAS score was 87% in the treatment group and 55% in the control group (P < .001), and the reduction in mean FFI-Rs score was 62% in the treatment group and 40% in the control group (P < .001). Treatment group and study visit were significant factors affecting both VAS and FFI-Rs scores. Overall, 92% were satisfied in the treatment group, and 78.2% in the control group. Postinjection pain occurred in 5 patients in the treatment group.

Conclusion:
This study provides Level I evidence regarding the efficacy and safety of allogeneic GF injection in patients with plantar fasciitis. However, additional studies are needed to evaluate their adverse effects, immunogenicity, and microbiological safety.
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NewsBot · Sep 26, 2020

Outcomes of platelet-rich plasma for plantar fasciopathy: a best-evidence synthesis
Tao Yu, Jiang Xia, Bing Li, Haichao Zhou, Yunfeng Yang & Guangrong Yu
Journal of Orthopaedic Surgery and Research volume 15, Article number: 432 (2020)

Background
Plantar fasciopathy (PF) is a very common disease, affecting about 1/10 people in their lifetime. Platelet-rich plasma (PRP) had been demonstrated to be useful in achieving helpful effects for plantar fasciopathy. The purpose of this study was to compare the pain and functional outcomes between PRP and corticosteroid (CS) or placebo for plantar fasciopathy through meta-analysis and provide the best evidence.

Methods
Literature was searched systematically to explore related studies that were published in Cochrane Library, PubMed, Embase, Medline, SpringerLink, OVID, and ClinicalTrials.gov. Articles regarding comparative research about the outcomes of PRP therapy and CS or placebo injection were selected. Data of pain and functional outcomes was extracted and imported into Reviewer Manager 5.3 to analyze.

Results
Thirteen RCTs were included and analyzed. Analysis results showed significant superiority of PRP in outcome scores when compared with CS (VAS: MD = − 0.85, P < 0.0001, I2 = 85%; AOFAS: MD = 10.05, P < 0.0001, I2 = 85%), whereas there is no statistical difference in well-designed double-blind trials (VAS: MD = 0.15, P = 0.72, I2 = 1%; AOFAS: MD = 2.71, P = 0.17, I2 = 0%). In the comparison of the PRP and the placebo, the pooled mean difference was − 3.76 (P < 0.0001, 95% CI = − 4.34 to − 3.18).

Conclusions
No superiority of PRP had been found in well-designed double-blind studies, whereas it is implied that the outcomes of PRP are better than placebo based on available evidence.
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NewsBot · Oct 12, 2020

Role of Platelet Rich Plasma in Chronic Plantar Fasciitis: A Prospective Study
R. B. Kalia, Vivek Singh, Nilotpal Chowdhury, Ashish Jain, Sanny Kumar Singh & Lakshmana Das
Indian Journal of Orthopaedics (2020)

Introduction
Autologous platelet rich plasma (PRP) local injection has been recently proposed as a treatment of plantar fasciitis. The autologous PRP does not have much side effects compared to steroid injections. So far PRP injections have shown promising results in various studies. This study assessed the efficacy of a single local injection of PRP in chronic unilateral plantar fasciitis through a prospective case series.

Methodology
A hospital-based prospective case series of 30 unilateral plantar fasciitis patients with symptom duration of 6 months or more were included in the study. All patients included in the study were assessed clinically and by visual analogue score for heel pain, AHS component of AOFAS and FADI scores before injection and at 6 and 12 week follow-up. USG measurement of plantar fascia thickness was done at pre-injection and at 12 weeks follow-up. All patients were observed for 12 weeks.

Results
The mean age was 39 years (range 20–55 years). The pre-injection VAS score for heel pain was 6.5 ± 1.1 which improved to 2.7 ± 0.5 and 1.8 ± 0.8 at 6 and 12 week respectively and difference was significant (p < 0.001). The baseline FADI and AHS component of AOFAS scores were 53.1 ± 9.0 and 72.2 ± 5.7 which improved to 65.5 ± 5.3 and 76.1 ± 4.5 at 6 weeks and, 77.9 ± 4.4 and 85.7 ± 4.6 at 12 weeks respectively which was significant (p < 0.001). The baseline mean plantar fascia thickness was 4.9 ± 0.3 mm which was significantly (p < 0.001) reduced to 3.9 ± 0.3 mm at 12 weeks post PRP injection. All pairwise comparisons by the post-hoc Wilcoxon signed rank test with p-value adjustment were also significant.

Conclusion
The short-term results of single dose PRP injections shows clinical and statistically significant improvements in VAS for heel pain, functional outcome scores and plantar fascia thickness measured by USG. This study concludes that local PRP injection is a viable management option for chronic plantar fasciitis.
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NewsBot · Dec 15, 2020

Autologous PRP Injection: A safe solution for Plantar Fasciitis
SparshNaikSaumyaAgarwalShivankPrakashRohitBhandariPrachiAgrawal
Journal of Arthroscopy and Joint Surgery; 10 December 2020

Background
Plantar fasciitis is one of the most common causes of heel pain and in its severe forms it can lead to functional disability also. This study has been taken up to evaluate the role of Platelet Rich Plasma (PRP) in managing chronic severe plantar fasciitis when other techniques have failed. This article also focuses on the pathophysiology, diagnosis, other non-operative treatment modalities and surgical options earlier used for plantar fasciitis.

Methods
For 92 patients of plantar fasciitis, PRP was prepared by double spinning technique, and then immediately injection was given after dorsiflexion of the ankle and injecting from the medial aspect of the foot. It was done as a day care procedure and the patients were examined after 1 week, 4 weeks and 12 weeks after the procedure

Results
After 12 weeks review, more than 60 patients showed great improvement in pain, with their VAS score of pain being below 7

Conclusion
The article suggests good and effective use of PRP in treatment of plantar fasciitis, along with being a simple and safe procedure.
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NewsBot · Feb 12, 2021

Autologous Platelet Rich Plasma (PRP) in the treatment of elbow epicondylitis and plantar fasciitis: medium to long term clinical outcome
Massimiliano Leigheb et al
Acta Biomed. 2020 Dec 30;91(14-S

Background and aim: Platelet-Rich-Plasma (PRP) is a popular biological therapy especially used to regenerate different musculoskeletal tissues by releasing growth-factors and cytokines promoting cell proliferation, chemotaxis, differentiation, and angiogenesis. The aim was to evaluate the clinical effectiveness and safety of PRP for Lateral-Epicondylitis (LE) of the elbow and Plantar-Fasciitis (PF).

Methods: A retrospective study was conducted including patients treated with a single topic autologous-PRP-injection between 1-1-2009 and 7-18-2019 for LE or PF at our institution; patients operated for the same problem, patients refusing the study or not traceable were excluded. Patients were assessed with VAS for pain and clinical scales.

Results: 33 patients were treated with PRP and 13 (8F, 5M) included: 4LE and 9PF for a total of 16 cases. The average pain level was 0.61±0.63: 1±1.41 for LE and 0,44±0 for PF. No significant side effect was reported. 4 PRP-treatments failed: 2LE and 2PF. OES and PRTEE gave excellent results for elbow. Average foot scores were AOFAS 98.2±5 and FADI 91.3±1. Patients were stratified and compared according to plantar arch conformation, follow-up length, healing time, time from diagnosis to PRP-treatment, therapies before PRP (physiotherapy, steroid infiltration or shock-waves), risk factors (standing work, sport, age, sex).

Conclusions: As in other studies, our results do not allow to draw sufficiently valid conclusions regarding the effectiveness and safety of PRP in the treatment of LE and PF: in particular the statistical significance is limited by the small sample size. PRP can be chosen as a non-first-line treatment for LE and PF.
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NewsBot · Jul 20, 2021

Role of Platelet Rich Plasma in Chronic Plantar Fasciitis: A Prospective Study
R B Kalia et al
Indian J Orthop. 2020 Oct 6;55(Suppl 1):142-148

Introduction: Autologous platelet rich plasma (PRP) local injection has been recently proposed as a treatment of plantar fasciitis. The autologous PRP does not have much side effects compared to steroid injections. So far PRP injections have shown promising results in various studies. This study assessed the efficacy of a single local injection of PRP in chronic unilateral plantar fasciitis through a prospective case series.

Methodology: A hospital-based prospective case series of 30 unilateral plantar fasciitis patients with symptom duration of 6 months or more were included in the study. All patients included in the study were assessed clinically and by visual analogue score for heel pain, AHS component of AOFAS and FADI scores before injection and at 6 and 12 week follow-up. USG measurement of plantar fascia thickness was done at pre-injection and at 12 weeks follow-up. All patients were observed for 12 weeks.

Results: The mean age was 39 years (range 20-55 years). The pre-injection VAS score for heel pain was 6.5 ± 1.1 which improved to 2.7 ± 0.5 and 1.8 ± 0.8 at 6 and 12 week respectively and difference was significant (p < 0.001). The baseline FADI and AHS component of AOFAS scores were 53.1 ± 9.0 and 72.2 ± 5.7 which improved to 65.5 ± 5.3 and 76.1 ± 4.5 at 6 weeks and, 77.9 ± 4.4 and 85.7 ± 4.6 at 12 weeks respectively which was significant (p < 0.001). The baseline mean plantar fascia thickness was 4.9 ± 0.3 mm which was significantly (p < 0.001) reduced to 3.9 ± 0.3 mm at 12 weeks post PRP injection. All pairwise comparisons by the post-hoc Wilcoxon signed rank test with p-value adjustment were also significant.

Conclusion: The short-term results of single dose PRP injections shows clinical and statistically significant improvements in VAS for heel pain, functional outcome scores and plantar fascia thickness measured by USG. This study concludes that local PRP injection is a viable management option for chronic plantar fasciitis.
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NewsBot · Apr 13, 2022

Efficacy of autologous platelet rich plasma injection in
plantar fascitis
Dr. C Ravindra Kumar, Dr. Arun KN and Dr. Suman NV
International Journal of Orthopaedics Sciences 2022; 8(1): 256-259

Background and Objectives: Platelet rich plasma has been used in sports medicine, for cartilage
degeneration and chronic enthesopathies like plantar fasciitis. Platelet-rich plasma exhibited the biological
healing capacity.
Methods: The study was conducted from December 2019 to December 2021, patients at the department
of orthopedics at Navodaya Medical College and Research Center, Raichur. Approval taken from ethical
committee. 30 patients selected based on the inclusion criteria and exclusion criteria. platelet rich plasma
injection intraleisionally given to all patients. All patients are evaluated with use of numerical pain score.
Results: The numerical pain scоre wаs аssessed at the time of injection. The mean numerical pain score of
all patients was 8.52 in plantar fasciitis. The mean numerical pain score for plantar fasciitis at 0, 1, 2, 4,
and 6 months was 8.52, 4.15, 2.38, 0.61, and 0.33, respectively. From the аbоvе dаtа, it can be concluded
that раtient receives mаximum relief оf sуmрtоms аt fourth month аnd is sustained until sixth mоnth.
Conclusion: In this study we observed platelet rich plasma has got significantly better results in plantar
fascitis safe and effective. This was observed maximum at 4 months and sustained for atleast 6 months.
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NewsBot · Apr 24, 2022

Role of Platelet Rich Plasma in the Management of Plantar Fasciitis: A Prospective Interventional Study.
BEZWADA, SRIDEVI; KHARE, TARUN; RAMAMURTHY, BHUVANAMHA DEVI; DEVISRIPRASAD, S.
Journal of Clinical & Diagnostic Research . Feb2022, Vol. 16 Issue 2, p14-18. 5p.

Introduction: Plantar Fasciitis (PF) is one of the most common chronic degenerative foot condition associated with pain in the bottom of the foot (enthesiopathy), encountered by an orthopaedic practitioner. Various treatment options have been implicated and it has been frustrating problem for both patients and treating doctors. Very limited studies are available showing the variable effects of Platelet Rich Plasma (PRP), the autologous conditioned plasma, in human tissues. Aim: To determine the role of PRP in the management of patients with PF. Materials and Methods: This prospective interventional study was conducted in the Department of Orthopaedics in collaboration with blood bank in SRM Medical College and Hospital, Potheri, Chengalpet district, Tamil Nadu, India, between November 2017 to April 2019. In this study, 70 patients with PF were treated with single dose of local injection of 3 mL autologous PRP. These patients were assessed for pain relief using the Visual Analogue Scale (VAS) and Foot and Ankle Ability Measure (FAAM). In addition ultrasonographic evaluation of thickness of plantar fascia was done six months after treatment. The statistical analysis of each clinical outcomes was analysed individually, using Statistical Package for the Social Sciences (SPSS) version 22.0. Statistical significance was done with student's t-test and p-value <0.05 was considered statistically significant. Results: The mean age of the patients in this study was 38.8±4 years. There were 39 (55.7%) female and 31(44.3%) male patients in the study. The mean symptom duration from the approximate onset of symptom to the study enrollment was 7±2.3 months. The statistically significant reduction in VAS score from the baseline and reduction in thickness of plantar fascia was observed in the study. FAAM score also gradually improved from mean 32.05±8.20 at baseline to 60.97±8.94 after 24 weeks with mean difference of 28.92. Conclusion: The present study observed that PRP is potentially effective and safe treatment option for long term relief of PF.
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NewsBot · May 31, 2022

A prospective study to analyse the efficacy of platelet
rich plasma in the treatment of chronic plantar fasciitis
P Krishna Balaji, A Senthilnathan, K Vijaya Shankar and R Prabhakar
International Journal of Orthopaedics Sciences 2022; 8(1): 201-204

Introduction: Regenerative medicine has been used in the treatment of various Musculo skeletal
disorders, chronic tendinopathies and in the field of sports medicine in the recent times. PRP is a
biological blood derived autologous component, rich in numerous growth factors and cytokines that will
lead to enhanced healing of bone and soft tissue at a cellular level.
Materials and Methods: 25 patients with unilateral chronic plantar fasciitis who were not responding to
conservative management for 6 weeks were included in this study. The study was done at Orthopaedics
department at RMMCH, Annamalai University from October 2020 to October 2021. Functional outcome
was evaluated using visual analog score [VAS] and Foot and ankle ability measure [FAAM] scores at
0,4,8,12, and 24 weeks. Plantar fascia thickness was measured pre-injection and 6 months post injection
using ultrasound.
Results: Patients had pre- treatment VAS score of 7.56and FAAM score of 30.04after 6 months follow
up the score improved to 1.32and 80.88respectively. Pre-treatment Plantar fascia thickness was 5.52mm,
6 months follow up study showed thickness of 3.56 mm.
Conclusion: Platelet rich plasma was found to be more effective in relieving the symptoms, increases the
functional outcome in long term follow up.
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NewsBot · Oct 27, 2022

Ultrasound-Guided Autologous Platelet-Rich Plasma Injections Versus Focal Ultrasound-Guided Extracorporeal Shockwave Therapy for Plantar Fasciitis in Athletes and Non-Athletes: a Retrospective Comparative Study with Minimum 2 Years Follow-Up.
Mattia Alessio-Mazzola, MD et al
October 26, 2022

Plantar fasciitis is often cause of heel pain, especially in sporting related activities. Different conservative measures for the management of plantar fasciitis were compared in several researches. The purpose of this retrospective study was to evaluate and compare clinical outcomes of chronic plantar fasciitis treated with ultrasound-guided platelet rich plasma (PRP) and focal ultrasound-guided extracorporeal shockwave therapy (ESW). Secondarily, results on sub-population of athletes were recorded.
Fifty-five patients treated for plantar fasciitis were included, 24 among them were competitive or recreational athletes. Treatment outcomes were assessed using Visual Analog Scale and Foot Function Index before and after treatment. Time to return to sport among patients practicing sporting activities was recorded. Before treatment, no differences were observed between groups in terms of age, gender, body mass index and months of follow up. From baseline to final follow-up assessment significant improvement was observed in all the outcomes measures. The subgroup analysis showed no differences between patients stratified for type of treatment and sport/non-sport practitioners. The overall failure rate was higher, although not significant, in patients who underwent ESW therapy and they required a higher number of orthopedic visits. Among sports practitioners the mean time to return to sport (months) was faster in PRP group than ESW group (p=0.044).
PRP and ESW represent both reliable solutions for plantar fasciitis leading to good results in terms of patients’ satisfaction, pain and clinical outcomes. However, after treatment with PRP injections less recurrences in overall population and faster return to sporting activities in sports practitioners were observed.
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NewsBot · Nov 17, 2022

The Statistical Fragility of Platelet-Rich Plasma as Treatment for Plantar Fasciitis: A Systematic Review and Meta-Analysis
Arjun Gupta et al
Source

Introduction/Purpose:
Plantar fasciitis (PF) is estimated to account for 8% of all running-related injuries, affecting nearly 1 out of every 10 adults aged 50 and older. Recent randomized controlled trials (RCTs) suggest platelet-rich plasma (PRP) injection may be an effective non-operative treatment option for chronic, refractory PF. However, RCTs in general have come under scrutiny due to a frequent lack of reproducibility, which is largely attributable to shortcomings of the commonly used p<0.05 threshold for significance. Fragility indices may be an appropriate tool to gauge the clinical importance of RCT findings in these situations. In this study, we utilize the continuous fragility index (CFI) and continuous fragility quotient (CFQ) to determine the statistical robustness of data from RCTs evaluating PRP for PF.
Methods:
RCTs comparing outcomes after PRP injection versus other conservative treatment in chronic PF patients were evaluated. Representative datasets were generated for each reported outcome event using summary statistics. The CFI was determined by manipulating each dataset until reversal of significance (a=0.05) was achieved. The corresponding CFQ was calculated by dividing the CFI by the sample size.
Results:
Of 259 studies screened, 27 studies (59 outcome events) were included in this analysis. The median CFI for all events was 9 (CFQ=0.177), suggesting that altering the treatment of only 9 patients (or 17.7 out of 100) would be sufficient to reverse trial significance (Table 1). Of the 36 outcome events reporting lost to follow-up data, 10 events (27.8%) lost >=9 patients. Outcome events that were originally reported as significant (p<0.05) were considerably more fragile (CFI=5; CFQ=0.122) than events that were reported as nonsignificant (CFI=10; CFQ=0.179).
Conclusion:
Fragility indices are a useful adjunct to p-values and provide an assessment of how easily statistical significance can be overturned. While there is some preliminary evidence supporting the clinical efficacy of PRP, our fragility analysis suggests that RCT findings may be underpowered in some cases. Over 27% of outcome events may have experienced a reversal of significance if the studies had simply maintained follow-up. Given the importance of RCTs in clinical decision-making, fragility indices should be reported alongside p-values to indicate the strength of statistical findings.
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NewsBot · Nov 21, 2022

Successful Treatment of Recalcitrant Plantar Fasciitis and Achilles Tendonitis using Platelet-Rich Plasma (PRP) Injection, Short and Intermediate Results
Peter G. Mangone, MD, Emma L. Binns, and Spencer Bock
Source

Introduction/Purpose:
PURPOSE: To identify is PRP is an effective alternative to surgery to decrease pain and increase activities for patients with recalitrant plantar faciiitis and Achilles tendonitis/tendonosis after failing greater than 6 months of appropriate conservative treatment. INTRODUCTION: PRP is thought to stimulate the body's natural mechanism of growth factors to promote healing of tissues. This is thought to occur through PRP transforming a chronic inflammatory degenerative process into a 'fresh' inflammatory process. Patients who undergo surgery for recalcitrant plantar fasciitis and Achilles tendonitis/tendonosis often have extended recovery time which can adversely affect employment status and lifestyle activities. The senior author began to use PRP is his orthopedic practice in 2015 as an alternative to surgery for patients with recalcitrant plantar fasciitis and Achilles tendonitis.
Methods:
From 2015 to 2020, patients with recalcitrant plantar fasciitis or Achilles tendonitis (symptoms >6 months and who had failed appropriate conservative measures) were given the choice to proceed with continued non-operative care vs. surgical intervention vs. a one-time PRP injection. All patients reported substantial pain affecting ADLs and recreational activities. All patients underwent preoperative MRI. Only patients with degenerative changes in the painful area on MRI were considered elegible for study inclusion. Informed consent was obtained for all participants prior to PRP injection. Subjects underwent a single PRP injection using a commercially avaialble FDA approved office based PRP centrifuge system. All PRP injections were performed by the senior author without ultrasound guidance using anatomical landmarks and the patient's maximum area of tenderness.
Patient subjective assessments of success/failure of the injection and percentage of pain relief using VAS were recorded at 6-8 weeks and > 1 year post injection.
Results:
89 PRP injections were performed on 88 patients (33 male/56 female). The Visual Analog Scale (VAS) was used to evaluate the treatment effectiveness along with the patient's subjective description of their improvement. Initial success was defined as >=50% pain decreased at 6-8 weeks post-injection. 55/89 subjects experienced relief >=50% at 6-8 weeks (overall 62% success rate). The average VAS improvement at 6-8 weeks was 67% for Achilles and 72% for plantar fasciitis (PF). 70 patients were available for intermediate follow-up (either in person or telephone) at an average of 27 months post-injection (range 13 - 41 months). For patients reporting >=50% continued pain relief, average VAS improvement was 83% for Achilles and 89% for PF. No patients with initial relief >=50% at 6-8 weeks had recurrent/worsened symptoms at intermediate follow-up. Patients with >=50% relief at 6-8 weeks trended toward further decreased pain over the next 12-24 months.
Conclusion:
This prospective case series study shows promising support of the short-term and intermediate-term effectiveness of PRP injection as a non-surgical treatment option for patients experiencing chronic recalcitrant plantar fasciitis and Achilles tendonitis. These results not only show a significant percentage of patients were able to avoid surgery with short term improvement in their symptoms, but the study also revealed that patients who experienced greater than 50% pain relief within the first 6 weeks after PRP injection, also showed continued improvement in their symptoms long term.
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NewsBot · Dec 19, 2022

Comparison of Regenerative Injection Therapy and Conventional Therapy for Proximal Plantar Fasciitis
Michael Matthews et al
Source

Treatment of subacute and chronic heel pain often presents a unique challenge to the physician. Regenerative therapies, such as injectable amnion and connective tissue matrix, may represent a promising new approach in these patients, and have become increasingly popular in the United States. However, little literature exists evaluating these injections compared to conventional nonoperative means. As such, we designed a retrospective comparative study evaluating patients in our practice who received a standardized plantar fascial treatment protocol only (standard therapy), and those who received regenerative plantar fascial injections in addition to standard therapy. A total of 54 patients were followed over a 3-month observation period (91.7 ± 73.9 days), with numeric pain rating (NPR) serving as the primary outcome. Both groups saw an improvement in NPR at the end of the observation period, but patients in the regenerative therapy group demonstrated lower pain scores than those receiving standard therapy alone (mean NPR 2.1 ± 2.3 vs 4.4 ± 2.8, p = .004). Additionally, those in the standard therapy group were significantly more likely to proceed onto surgical intervention compared to the regenerative therapy group (unadjusted odds ratio 15.6, 95% CI 3.0-27.9). The use of regenerative injections for subacute and chronic plantar fasciitis showed promise in our study, and may help mitigate against the need for invasive surgical intervention.
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NewsBot · Jan 17, 2023

The Statistical Fragility of Platelet-Rich Plasma as Treatment for Plantar Fasciitis: A Systematic Review and Simulated Fragility Analysis
Arjun Gupta et al
Foot Ankle Orthop. 2022 Dec 24

Background: Plantar fasciitis (PF) is the most common cause of heel pain and can be a source of extensive physical disability and financial burden. Platelet-rich plasma (PRP) offers a potentially definitive, regenerative treatment modality that, if effective, could change the current paradigm of PF care. However, randomized controlled trials (RCTs) on the clinical benefits of PRP for refractory PF offer inconsistent conclusions, potentially because of the broader limitations of using P value thresholds to declare statistical and clinical significance. In this study, we use the Continuous Fragility Index (CFI) and Quotient (CFQ) to appraise the statistical robustness of data from RCTs evaluating PRP for treatment of PF.

Methods: RCTs comparing outcomes after PRP injection vs alternative treatment in patients with chronic PF were evaluated. Representative simulated data sets were generated for each reported outcome event using summary statistics. The CFI was determined by manipulating each data set until reversal of significance (α=0.05) was achieved. The corresponding CFQ was calculated by dividing the CFI by the sample size.

Results: Of 259 studies screened, 20 studies (59 outcome events) were included in this analysis. From these simulations, the median CFI for all events was 9, suggesting that varying the treatment of 9 patients would be required to reverse trial significance. The corresponding CFQ was 0.177. Studies with reported P value <.05 were more statistically fragile (CFI=10, CFQ=0.122) than studies with reported P value >.05 (CFI=5, CFQ=0.179). Of 36 outcome events reporting lost to follow-up data, 10 events (27.8%) lost ≥9 patients.

Conclusion: Our findings suggest that, on average, the statistical fragility of RCTs evaluating PRP for nonoperative PF therapy is at least comparable to that of the sports medicine literature. However, several included studies had concerningly low simulated fragility scores. Orthopaedic surgeons may benefit from preferentially relying on studies with higher CFI and CFQ values when evaluating the utility of PRP for chronic PF in their own clinical practice. Given the importance of RCT data in clinical decision making, fragility indices could help give context to the stability of statistical findings.
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NewsBot · Jul 20, 2023

Analgesic efficacy and functional outcome in
refractory cases of plantar fasciitis treated with
platelet-rich plasma: randomized comparative
study with corticosteroids injection
Zeinab Hamed Sawan et al
Source

Background: Steroid injection is a widespread treatment for plantar fasciitis but seems to be
useful to a lesser extent, Platelet-rich Plasma (PRP) injections into the plantar fascia start the
healing process required to stop the degeneration of the plantar fascia at its root.
Aim of the study: To compare analgesic efficacy, functional outcome, degree of satisfaction
and improvement of fascial thickness and echogenicity after platelet-rich plasma injection
versus corticosteroids injection in refractory cases of plantar fasciitis.
Patients & method: 60 patients with refractory plantar fasciitis who were resistant to conservative treatment were randomized to receive either PRP or steroid injection. All patients
were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) score, Visual
Analogue Score (VAS) for pain, the Roles-Maudsley (RM) Score and plantar fascia thickness and
echogenicity. Data were collected prospectively, pre-treatment, at 3, 6, 12 week, and 6 months
post-injection.
Results: There was significant improvement in both groups as regards the clinical outcome
measures involving (VAS & AOFAS) and radiological outcome measures including (thickness
and echogenicity) in all post-injection times. However, steroid group showed early improvement (at 3rd week post-injection) with short duration while PRP group showed improvement at
12 weeks post-injection till the end of the study.
Conclusion: The use of PRP injection is safer with better analgesia and functional outcome
than steroid therapy for treating chronic plantar fasciitis.
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NewsBot · Sep 25, 2023

A randomized study comparing the effect of platelet-rich plasma and platelet-poor plasma for the treatment of plantar fasciitis
Elcio Valotto-Junior et al
Research, Society and Development, [S. l.], v. 12, n. 9, p. e7812943168, 2023.

Objective: To verify the effectiveness of therapy with platelet-rich plasma (PRP) in patients with plantar fasciitis, this prospective, longitudinal, double-blind study was carried out. Methodology: Twenty-three participants with chronic plantar fasciitis aged > 20 years, already treated with conventional methods were included. Participants were randomly divided into platelet-poor plasma (PPP) and platelet-rich plasma (PRP) groups. Double centrifugation was carried out to prepare the platelets samples and two millilitres of PPP (supernatant fraction) or PRP (sediment fraction) were mixed with 1mL of 2% calcium gluconate solution and injected in the plantar fascia, as a single dose. A follow-up at 15 days and then every 60 days up to 180 days of application was carried out and a visual analogue scale (VAS) for pain assessment and the quality-of-life scale validated by the American Orthopedic Foot and Ankle Society (AOFAS) were used to measure the outcomes. Results: A reduction in pain (VAS 8 to 4), in both groups, was seen in the first 15 days and remained up to the 6th month after the application of plasmas, however, no difference was observed between the groups. No significant improvement was observed in the quality of life of the patients. Conclusion: PPP or PRP were able to reduce the VAS, but the presence of platelets did not have a role in the pain relief. Other factors in the plasma may play a role in reducing the pain caused by plantar fasciitis for a period of up to 180 days.
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NewsBot · Jan 8, 2024

New Infiltration Technique in the Treatment of the Plantar Fascia Syndrome Based on Platelet-Rich Plasma
Francesc Pardo-Camps et al
J. Clin. Med. 2024, 13(1), 170

Pain in the attachment of the plantar fascia in the calcaneus represents 10% of all sports injuries, affects 10% of foot runners, and will affect around 20% of the world population. There is no effective conservative treatment for it. This paper justifies a new definition and name for this pathology, Plantar Fascia Syndrome (PFS), presents a methodology for its diagnosis, and presents the clinical and functional effectiveness of a new conservative treatment based on platelet-rich plasma (PRP). In total, 25 patients (from an initial sample of 260) diagnosed with recalcitrant PFS lasting for more than 12 months were treated with a single infiltration of 2 mL of PRP, according to a new technic proposed. The study was approved by the ethical committee for clinical research of the reference hospital. The patients were controlled after 15, 30, 90, and 180 days, reviewing on each occasion pain, thickness of the plantar fascia, and active extension of the ankle joint. A total of 15 days after infiltration, 85% of patients had no clinical signs requiring treatment. After 90 days of infiltration, no patients showed clinical signs. This improvement in the patients’ condition lasted for 180 days. All patients after treatment can fully resume normal activity with no pain.
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NewsBot · Feb 24, 2024

Efficacy and Safety of Platelet-Rich Plasma Injection for Chronic Plantar Fasciitis: A Prospective Study on Functional Restoration and Pain Relief
Udit Kothari et al
Cureus. 2024 Jan 16;16(1):e52414

Background Heel discomfort and functional impairment are frequently caused by plantar fasciitis, and treating it can be extremely difficult for clinicians and occasionally have unfavorable clinical consequences. Recently, platelet-rich plasma (PRP) has been used as an alternative therapy for plantar fasciitis (PF) to reduce heel pain and improve functional restoration. We evaluated the current evidence concerning the efficacy and safety of PRP as a treatment for PF. Methodology This was a hospital-based prospective study on patients with plantar fasciitis with a symptom duration of six months or more with failed conservative therapy. All patients included in the study were assessed clinically and by a visual analog score (VAS) for heel pain, the Ankle-Hindfoot Scale (AHS) component of the American Orthopedic Foot and Ankle Society (AOFAS) and Foot and Ankle Ability Measure (FAAM) scores before injection, and at three weeks, three and six-months post-PRP treatment follow-up. Ultrasonography (USG) measurement of plantar fascia thickness was done pre-injection and at the six-month follow-up for clinical outcomes and any complications. Results The study included 25 patients with plantar fasciitis, with the majority (48%) in the age group of 21-30 years. Females accounted for 64% of the patients while males accounted for 36%. Most patients (56%) had a moderately active daily activity level. The study found that 16 patients had bilateral plantar fasciitis while nine had unilateral plantar fasciitis. Among the patients with bilateral plantar fasciitis, a total of 32 heels were affected while the 9 patients with unilateral plantar fasciitis had 9 affected heels. Most female patients (75%) had bilateral plantar fasciitis while most male patients (56%) had unilateral plantar fasciitis. Before PRP therapy, both male and female patients reported high pain scores on the VAS for both heels. However, after PRP infiltration, the VAS scores significantly decreased at three weeks, three months, and six months post-injection, indicating pain relief. The AOFAS hindfoot and ankle scores and FAAM scores showed improvement over the follow-up period. Both male and female patients experienced significant improvements in functional outcomes, with increases in AOFAS (p-value 0.45) and FAAM scores (p-value 0.31) at three weeks, three months, and six months post-injection compared to baseline. Statistical analysis revealed a significant decrease in pain scores (73% pain relief), as well as significant improvements in AOFAS scores with an average of 22.33 from baseline (mean = 67.75±9.7) to final follow-up (mean = 90.08±7.9) and FAAM scores with an average of 23.72 from baseline (mean = 49.38±5.2) to final follow-up (mean = 73.10±5.2) after PRP infiltration. Conclusion The outcomes of a single dosage of PRP injections demonstrate clinically and statistically substantial improvements in functional outcome scores, plantar fascia thickness evaluated by USG, and VAS scores for heel pain. According to the results of this study, local PRP injection is an effective treatment for chronic plantar fasciitis.
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NewsBot · Feb 28, 2024

Platelet rich plasma therapy versus other modalities for treatment of plantar fasciitis: A systematic review and meta-analysis
Agustin Herber et al
Foot Ankle Surg. 2024 Feb 15:S1268-7731(24)00031-6

Introduction: Plantar fasciitis (PF) is the most common cause of heel pain in adults. There are numerous non-operative treatments available including platelet rich plasma (PRP) injections. PPR has demonstrated effectiveness for a range of musculoskeletal conditions including plantar fasciitis.

Purpose/objective: To compare the effectiveness of PRP to other conservative treatment options for the management of PF.

Methods: A systematic search of PubMed and Google Scholar was performed for randomized control trials (RCT) comparing PRP to other treatment modalities. Studies met inclusion criteria if mean and standard deviations for visual analog scale (VAS) pain scores, plantar fascia thickness (PFT), Foot Function Index (FFI), or American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score were reported. Mean differences (MD) were used to compare VAS pain, PFT, FFI, and AOFAS between PRP and other treatments.

Results: Twenty-one RCTs which altogether included 1356 patients were included in the meta-analysis. PRP demonstrated significantly greater improvements in VAS pain scores compared to extracorporeal shock wave therapy (ESWT) (SMD: 0.86; CI: [0.30, 1.41]; p = 0.002), corticosteroid injections (CSI) (SMD: 1.08; CI: [0.05, 2.11]; p = 0.04), and placebo (SMD: 3.42; CI: [2.53, 4.31]; p < 0.00001). In terms of FFI, no significant differences existed among PRP, ESWT, CSI, dextrose prolotherapy (DPT), and meridian trigger points (MTP) in enhancing foot functionality. However, PRP demonstrated a marked advantage over phonophoresis, showing a substantial improvement in FFI scores (SMD: 3.07, 95% CI: 2.34-3.81). PRP did not demonstrate superiority over ESWT, CSI, or MTP for improving PFT, but it was notably more effective than phonophoresis (SMD: 3.18, 95% CI: 2.43-3.94). PRP demonstrated significantly greater improvements in AOFAS scores over CSI (SMD: 3.31, CI: [1.35, 5.27], p = 0.0009) and placebo (SMD: 3.75; CI: [2.81, 4.70]; p < 0.00001).

Conclusion: PRP is more effective than CSI, ESWT, and placebo in reducing VAS and more effective than CSI and placebo in improving AOFAS. PRP did not demonstrate a consistent advantage across all outcome measures, such as PFT and FFI. These findings underscore the complexity of PF treatment and call for a more standardized approach to PRP preparation and outcome measurement.
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Platelet Rich Plasma for plantar fasciitis

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Platelet Rich Plasma for plantar fasciitis

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