Comparative Prospective Study Between Platlete Rich Plasma and Steroid Injection in Treatment of Chronic Planter Fasciitis

Document Type : Original Article

Authors

1 Department of Orthopedics and Traumatology, Faculty of medicine, Sohag university, Egypt

2 Department of Orthpaedic and Traumatology , Faculty of Medicine, Sohag University.

3 Department of Orthopedics and Traumatology, Faculty of medicine, Sohag university, Egypt.

Abstract

Purpose:Compare the results of injection of steroid and PRP in cases of chronic plantar fasciitis
INTRODUCTION: plantar fasciitis can be a difficult condition to treat. results of platelet rich plasma (PRP) injection have been promising. We compared PRP to cortisone injection in the treatment of chronic plantar fasciitis resistant to conservative management.
METHODS:38 heels (20 heels in the steroid group and 18heels in the PRP group)  with  plantar fasciitis  failed conservative treatment were included to receive either PRP or Steroid injection. All patients were assessed by Visual Analogue Score (VAS) for pain, at 2 weeks 1 month and 3months post injection .
RESULTS:Our study included 38 patients; 20 in the steroid arm and 18 had PRP injections. The average age of the steroid injection group was 43.1±9.7 years and in the PRP was 43.1±8.4 years (P= 0.698).
The starting average pain scores were 8.6 for both groups
(P= 0.712). Then our patients were followed up clinically at 2 weeks, 1 month and 3 months following the injections. There was statistically significant lower VAS scores for the steroid injection group at all follow up visits (P< 0.001 in all follow ups). The average pain scores were 4.9 and 6.7 at 2 weeks follow up for the steroid injection versus the PRP respectively, it was 2 and 4.2 at 1 month and last 0.6 and 1.2 after 3 months respectively.
CONCLUSIONS:PurposThe purpose of this study was to assess the safety and preliminary clinical results of platelet-rich plasma (PRP) injections for treating chronic plantar fasciitisMethods
Fourteen consecutive patients with chronic plantar fasciitis receiving three injections of PRP into the plantar fascia were assessed 12 months after the procedure. The modified Roles and Maudsley score and a visual analogue scale (VAS) for pain were used to evaluate the clinical results.
Results
According to criteria of the Roles and Maudsley score, at 12 months of follow-up, results were rated as excellent in nine (64.3 %), good in two (14.3 %), acceptable in two (14.3 %) and poor in one (7.1 %) patient. VAS for pain was significantly decreased from 7.1 ± 1.1 before treatment to 1.9 ± 1.5 at the last follow-up (p < 0.01).
Conclusions
In this single-centre, uncontrolled, prospective, preliminary study, results indicate that treating chronic plantar fasciitis with PRP injections is safe and has the potential to reduce pain.
This study demonstrates that both steroid and  PRP injections  are highly effective in treatment of chronic  plantar fasciitis but improvement in pain was more rapid with steroid injection. This study recommends for follow up for a longer period than three months to compare long term benefits of steroids and PRP.

References

1. Dunn JE, Link CL, Felson DT et al. Prevalence of foot and ankle conditions ina multiethnic community sample of older adults. Am J Epidemiol 2004; 159:491–498.       
2. Riddle DL, Schappert SM. Volume of ambulatory care visits and patterns ofcare for patients diagnosed with plantar fasciitis: a national study of medicaldoctors. Foot Ankle Int 2004; 25: 303–310.
3. Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for plantar fasciitis: amatched case-control study. J Bone Joint Surg Am 2003; 85: 872–877.
4. Gill LH. Plantar fasciitis: diagnosis and conservative management. J Am AcadOrthopSurg 1997; 5: 109–117 
5. Hicks JH. The mechanics of the foot. II. The plantar aponeurosis and the arch.J Anat 1954; 88: 25–30.
6. Woolnough J. Tennis heel. Med J Aust 1954; 2: 857.
7. Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process(fasciosis) without inflammation. J Am Podiatr Med Assoc 2003; 93: 234–237.
8. Schon LC, Glennon TP, Baxter DE. Heel pain syndrome: electrodiagnosticsupport for nerve entrapment. Foot Ankle 1993; 14: 129–135.
9. Tanz SS. Heel pain. ClinOrthopRelat Res 1963; 28: 169–178. 
10. Shmokler RL, Bravo AA, Lynch FR, Newman LM. A new use of instrumentation in fluoroscopy controlled heel spur surgery. J Am Podiatr Med Assoc 1988; 78:194–197.
11. Chimutengwende-Gordon M, O’Donnell P, Singh D. Magnetic resonance imagingin plantar heel pain. Foot Ankle Int 2010; 31: 865–870.
12. Donley BG, Moore T, Sferra J et al. The efficacy of oral nonsteroidal anti-inflammatory medication (NSAID) in the treatment of plantar fasciitis: arandomized, prospective, placebo-controlled study. Foot Ankle Int 2007; 2820–23
13. Crawford F, Atkins D, Young P, Edwards J. Steroid injection for heelpain: evidence of short-term effectiveness. A randomized controlled trial.Rheumatology 1999; 38: 974–977.
14. Acevedo JI, Beskin JL. Complications of plantar fascia rupture associated withcorticosteroid injection. Foot Ankle Int 1998; 19: 91–97.
15. Leach R, Jones R, Silva T. Rupture of the plantar fascia in athletes. Bone JointSurg Am 1978; 60: 537–539.
16. DiGiovanni BF, Nawoczenski DA, Lintal ME et al. Tissue-specific plantar fasciastretchingexercise enhances outcomes in patients with chronic heel pain. Aprospective, randomized study. J Bone Joint Surg Am 2003; 85: 1,270–1,277.
17. DiGiovanni BF, Nawoczenski DA, Malay DP et al. Plantar fascia-specificstretching exercise improves outcomes in patients with chronic plantar fasciitis.A prospective clinical trial with two-year follow-up. J Bone Joint Surg Am 2006;88: 1,775–1,778.
18. Wolgin M, Cook C, Graham C, Mauldin D. Conservative treatment of plantarheel pain: long-term follow-up. Foot Ankle Int 1994; 15: 97–102.
19. Snook GA, Chrisman OD. The management of subcalcaneal pain. ClinOrthopRelat Res 1972; 82: 163–168.
20. Furey JG. Plantar fasciitis. The painful heel syndrome. J Bone Joint Surg Am
1975; 57: 672–673.
21. Babcock MS, Foster L, Pasquina P, Jabbari B. Treatment of pain attributed toplantar fasciitis with botulinum toxin a: a short-term, randomized, placebocontrolled,double-blind study. Am J Phys Med Rehabil 2005; 84: 649–654.
22. Ogden JA, Alvarez RG, Levitt RL et al. Electrohydraulic high-energy shockwavetreatment for chronic plantar fasciitis. J Bone Joint Surg Am 2004; 86:2,216–2,228.
23. Hammer DS, Rupp S, Kreutz A et al. Extracorporeal shockwave therapy (ESWT)
in patients with chronic proximal plantar fasciitis. Foot Ankle Int 2002; 23:309–313.
24. Wang CJ, Chen HS, Huang TW. Shockwave therapy for patients with plantarfasciitis: a one-year follow-up study. Foot Ankle Int 2002; 23: 204–207.
25. Gerdesmeyer L, Frey C, Vester J et al. Radial extracorporeal shock wave therapyis safe and effective in the treatment of chronic recalcitrant plantar fasciitis:results of a confirmatory randomized placebo-controlled multicenter study. AmJ Sports Med 2008; 36: 2,100–2,109.
26. Anderson RB, Foster MD. Operative treatment of subcalcaneal pain. Foot Ankle1989; 9: 317–323.
27. Murphy GA, Pneumaticos SG, Kamaric E et al. Biomechanical consequences ofsequential plantar fascia release. Foot Ankle Int 1998; 19: 149–152.
28. Baxter DE, Pfeffer GB. Treatment of chronic heel pain by surgical release ofthe first branch of the lateral plantar nerve. ClinOrthopRelat Res 1992; 279:229–236.
29. Barrett SL, Day SV, Pignetti TT, Egly BR. Endoscopic heel anatomy: analysis of200 fresh frozen specimens. J Foot Ankle Surg 1995; 34: 51–56 
30. Marafkَ C. Endoscopic partial plantar fasciotomy as a treatment alternative inplantar fasciitis. ActaChirOrthopTraumatolCech 2007; 74: 406–409.
31. Hogan KA, Webb D, Shereff M. Endoscopic plantar fascia release. Foot Ankle
Sohag Medical Journal
Volume 22, Issue 1
January 2018
Pages 181-186

Files

Share

How to cite

Statistics