A Guide To Conservative Care For Plantar Heel Pain
- Volume 26 - Issue 11 - November 2013
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The use of custom foot orthotics comes down to each clinician’s preference and skills in deciding to use these as treatment options. Some clinicians prefer a different treatment regimen in which they exclude the use of orthotics while others will cast or scan several patients a day for orthotics to address various pathologies. There is no high-level evidence to support the use of orthotics but as a profession, we know there are successful outcomes with custom foot orthotics.
Does PRP Offer Promise For Plantar Fasciitis?
Platelet-rich plasma (PRP) has gained notoriety over the past several years. It is not only one of the newer options available for treating plantar fasciitis but clinicians may also use PRP to treat tendinopathy, ulcers, and various osseous pathologies. Plasma taken from one’s own body contains numerous growth factors and recent reports on PRP have been favorable. In a prospective study, Kumar and colleagues found a 64 percent satisfaction rate with PRP injections for intractable plantar fasciitis while Aksahin and coworkers found similar relief when comparing corticosteroid injection to PRP.37,38 In another study of PRP for chronic plantar fasciitis, Ragab and his co-authors cited a decrease in pain from a 9.1 to 1.6 on the visual analogue scale and there was a 96 percent satisfaction rate. Post-injection ultrasonography identified a thinner plantar fascia with less signal intensity.
Currently, clinicians would just inject PRP once and not through a series of injections. While PRP offers a safe alternative to corticosteroid injections, the high cost and lack of insurance coverage are pitfalls for patients electing to have this procedure. While there is no high-level evidence on the efficacy of PRP for plantar fasciitis, the results of some of these recent studies appear promising.
While plantar fasciitis is likely one of the most treated conditions in our offices, there is no solid evidence of what is most effective and most treatment is based on how we were trained, or what has worked in our clinical practices. The realm of treatment is always expanding with several new methods available. While these modalities do seem promising, there are no concrete studies to support their effectiveness. The longer one is in practice, the likelier he or she is going to adhere to what he or she has always practiced, but it doesn’t hurt to step out of the box every once and a while and try something new.
Dr. Yakel is in private practice in Boulder, Colo. He is the Immediate Past President of the American Academy of Podiatric Sports Medicine, and is the team podiatrist for the Colorado Rapids of Major League Soccer.