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Injection therapy for heel pain

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Jul 26, 2006.

  1. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1

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    Comparison of Injection Modalities in the Treatment of Plantar Heel Pain: A
    Randomized Controlled Trial

    J Am Podiatr Med Assoc 96(4): 293–296, 2006
     
  2. Admin2

    Admin2 Administrator Staff Member

  3. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Intralesional autologous blood injection compared to corticosteroid injection for treatment of chronic plantar fasciitis. A prospective, randomized, controlled trial.Lee TG, Ahmad TS.
    Foot Ankle Int. 2007 Sep;28(9):984-90.
     
  4. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Treatment of Plantar Fasciitis Using Four Different Local Injection Modalities
    A Randomized Prospective Clinical Trial

    Aydiner Kalaci, Hüsamettin Çakici, Onur Hapa, Ahmet Nedim Yanat, Yunus Dogramaci and Teoman Toni Sevinç
    Journal of the American Podiatric Medical Association Volume 99 Number 2 108-113 2009
     
  5. Am I being dense here?!:bash:

    How can P = 0?

    And Groups A & B? Good results? Bad? Indifferent? Seem odd to just ignore them! Based on the P=0 for improvement one would think it would be worth mentioning!

    When i get a min I might have to have a look at the raw data! Seems a bit Pete Tong to me!

    Regards
    Robert
     
  6. So the pain reduction was by almost 50% in A and B and considerably better in C&D.

    Which raises an interesting question. Given that the improvement was similar for blood and LA in groups A & B, what was the mechanism for this? And why did the peppering create a different effect in the steroid group but not in the La / Blood groups!

    Prolotherapy or placebo. Will we ever know?

    Regards
    Robert
     
  7. AllForThePatient

    AllForThePatient Welcome New Poster

    I paid no attention to platelet gel therapy until a meeting a few months back where a f/a MD was chatting about it during a break. i tried it with a few of my chronic pf patients who had already had multiple cortisone injections which had stopped working. 3-5 of my patients had dramatic relief 2 weeks out. One had relief after the 2nd treatment and one had negligible pain subsidence.

    If you allow yourself to strip down the science of what is happening, it is difficult to shun the idea that this is an effective and commen-sense treatment for an infinite quanity of podiatry applications and just about every other area of medicine. Cortisone draws inflammation away from a site. When platelets are ignited by the thrombin, they release an army of growth factors which create inflamation and facilitate the healing process. I now spend half of a day per week essentially with a pf clinic, injecting patients who line up by referal even though they have to pay cash. I have the kits on the shelves of my office at as much of a discount as is given and frankly, the system has become a cash cow. Not one patient has complained of the expense. I've also begun to use platelet gel for many other areas of my practice and I believe that we will soon look back and laugh about the days that we went without it.

    Mike
     
  8. Griff

    Griff Moderator

    .....
     

    Attached Files:

  9. Griff

    Griff Moderator

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    Attached Files:

  10. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    This clinical trial was just registered:

    Treatment of Plantar Fasciitis With Platelet Rich Plasma
     
  11. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Image Intensifier-Guided Injection of Corticosteroid and Local Anesthetic Agent for the Treatment of Recalcitrant Plantar Fasciitis.
    Atkins KL, Chin KF, Noorani AM, Nairn DS.
    Foot Ankle Spec. 2010 Jun 18. [Epub ahead of print]
     
  12. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Sonographically guided corticosteroid injection for treatment of plantar fasciosis.
    Kayhan A, Gökay NS, Alpaslan R, Demirok M, Yilmaz I, Gökçe A.
    J Ultrasound Med. 2011 Apr;30(4):509-15.
     
  13. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Plantar fasciitis - to jab or to support? A systematic review of the current best evidence
    Uden H, Boesch E, Kumar S.
    J Multidiscip Healthc. 2011;4:155-64.
     
  14. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    This clinical trial was recently registered:

    Treatment of Plantar Fasciitis With Injection af Platelet-rich Plasma Into the Origin of the Plantar Fascia
     
  15. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Platelet-Rich Rich Plasma is More Effective than Cortisone for Chronic Severe Plantar Fasciitis
    Raymond R. Monto
    Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.
     
  16. It's not. It is being reported here to three decimal places.
     
  17. Dawn Bacon

    Dawn Bacon Active Member

    Some really interesting work going on in this area at present. It seems that there are two main approaches to the autologous injection treatments:
    Platelet-rich plasma
    IL1 receptor antagonist protein

    Having had a good look around the research in the area the vets appear to have done some extensive work and I would suggest that this paper is worth a look:

    http://www.sciencedirect.com/science/article/pii/S0749073911000241

    Best wishes,
    Dawn
     
  18. Perthpod

    Perthpod Active Member

    Hi Robert,

    We wont know whether peppering created a different effect in LA and autolog groups, because peppering was too painful with the autologous group (even though their lit reveiew includes Kiter who performed this method) and there was no normal ligno injection. The only data on peppering left to compare is the cort. group. Hmmm. They also used peppering with saline (too painful to cont.). Makes you wonder whether people even think about methodology? I would have liked to have at least seen ligno normal vs. ligno pepp and cort normal and cort pepp. They could have neatly left it at that. Also the validity of the modified Roles and Maudsley Score is questionable. Was it only modified from a tennis elbow study to a weightbearing study by these authors?

    Pip
     
  19. N.Knight

    N.Knight Active Member

    I am currently doing a literature review in the use of autologous blood (PRP and whole blood) and it’s use in sporting injuries and grading the current levels of evidence.

    Pip, I agree reading quite a few articles now, I pull my hair out at some of these methods, people put hard work in the studies and appear lazy in their methods that really affect the level of evidence. There is a few level 4 studies, however nothing really above that for heel pain. There is a study in USA in the recruitment phase that reading the initial method looks promising

    I have attached the full version of this paper.

    Thanks,

    Nick
     

    Attached Files:

  20. Perthpod

    Perthpod Active Member

    Thanks Nick,

    That is the Kiter referenced by Kalaci that I was talking about. I feel that there really needs to be some solid trials separating out the methods, rather than mixing them up. It is hard to explain results when the variables are jumbled eg the aforementioned Kalaci missing variable and the ligno/autolog mix in Kiter. As we were saying.

    Cheers, Pip
     
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