April 2010

Can PRP Injections Relieve Pain From Chronic Achilles Tendinopathy?

By Brian McCurdy, Senior Editor

   Platelet rich plasma (PRP) injections are among the treatment options for the commonly presenting problem of chronic Achilles tendinopathy. Although a recent study in the Journal of the American Medical Association (JAMA) concludes that PRP does not show a significant benefit for the condition, several DPMs have experienced promising results.

   Researchers focused on 54 patients with chronic Achilles tendinopathy. Patients were randomized to receive either PRP injection with eccentric exercises or a placebo with eccentric exercises. Patients evaluated their pain level and activity by completing the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire.

   After 24 weeks, the mean VISA-A score improved by 21.7 points in the PRP group in comparison to 20.5 points in the placebo group, according to the study. The difference in scores was not statistically significant according to the study authors, who concluded that PRP did not lead to improvement in pain and activity in patients with chronic Achilles tendinopathy.

Raising Questions About The Study

   While the study researchers noted no statistically significant differences between groups, Stephen Barrett, DPM, questions the injection method used in the study. In his eight years of experience of using PRP for plantar fasciosis, he has found that the more one “needles” or debrides the degenerative tissue, the better the outcome. Dr. Barrett says PRP is particularly effective in treating plantar fasciosis because one can intervene without disrupting the biomechanics of the plantar fascia.

   Furthermore, Dr. Barrett says if the study authors had employed pre- and post-op ultrasound in their study, this may have revealed discernible differences between the two groups of treated tendons. In his work with PRP in the plantar fascia, Dr. Barrett has seen complete regeneration with normal ultrasonographic findings, noting that ultrasound comparison provides an objective measurement rather than the subjective pain scale used in the study.

   Dr. Barrett concedes that ultrasound findings do “not always correlate to the clinical situation.” He has discovered that many patients who experience complete pain relief have abnormal ultrasound findings but notes there are “sparsely few” patients who are not pain free with regenerated fascia.

DPMs Cite ‘Promising Results’ With PRP

   David Soomekh, DPM, has seen promising results in using PRP to treat chronic Achilles tendinopathy with the most improvement in patients who have had pain and loss of function for more than six months and who also have failed conservative therapy.

    “Most patients have returned to normal and increased activities with a significant reduction or total resolution of their pain,” says Dr. Soomekh, a Fellow of the American College of Foot and Ankle Surgeons.

   Dr. Soomekh has been surprised to find a reduction in the number of tendon nodules after the use of PRP. He has also found good results in using PRP for posterior tibial tendons.

   In regard to platelet activation, Dr. Barrett adds that he has used low-energy radial shockwave immediately after the administration of the PRP injection.

    “I believe PRP holds great promise for the future treatment of musculoskeletal conditions and is proving to be the case in our management of plantar fasciosis,” says Dr. Barrett, a Fellow of the American College of Foot and Ankle Surgeons.

   In the few patients with Achilles tendinopathy whom he has treated with PRP, Dr. Barrett has experienced no complications and cities only a limited risk of infection as a downside to PRP.

Is ESWT Effective In The Long Run?

By Lauren Grant, Editorial Assistant

   While a variety of studies have examined the effects of extracorporeal shockwave therapy (ESWT), a recent study presented at the American College of Foot and Ankle Surgeons Annual Scientific Meeting found favorable outcomes in patients with plantar fasciitis nine years after treatment.

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