Can Plantar Fasciitis Patients Get Long-Term Relief From PRP?
By Brian McCurdy, Senior Editor
A new study in Foot and Ankle International finds that platelet rich plasma (PRP) is more effective over a longer time period for patients with plantar fasciitis in comparison with cortisone injections.
Researchers focused on 40 patients with unilateral chronic plantar fasciitis that did not respond to a minimum of four months of standardized traditional, non-operative treatment modalities. Patients had either a single ultrasound guided injection of 3 cc PRP or 40 mg of methylprednisolone (Depo-Medrol, Pfizer) cortisone.
The PRP group started with an average pre-treatment American Orthopedic Foot and Ankle Society (AOFAS) score of 37, which increased to 95 at three months and was 92 at 24 months, according to the study. The study notes that the cortisone group had a pre-treatment average AOFAS score of 52, which initially improved to 81 three months after treatment but by 24 months had declined to a final score of 56.
In his practice, Bob Baravarian, DPM, has seen success rates of 60 to 70 percent when treating chronic plantar fasciosis with PRP. He uses two to three injections three to four weeks apart, and says the key is repeated injections.
David Soomekh, DPM, has seen patients do very well after PRP injections for the treatment of chronic plantar fasciitis. In his experience, 60 percent of patients will relate complete recovery after two months while 80 percent will relate at least 50 percent relief of their symptoms. Ninety percent of the remaining patients have significant relief after a second injection, notes Dr. Soomekh, a Fellow of the American College of Foot and Ankle Surgeons, the Founder/Director of the Foot & Ankle Specialty Group in Beverly Hills and Official Physician for the Los Angeles Ballet. In comparison to cortisone injections, PRP relieves pain and symptoms for a longer period of time, according to Dr. Soomekh.
“(Platelet rich plasma) will not give instant relief like a cortisone injection can, yet it will give them longer relief,” notes Dr. Soomekh.
Cortisone is a good early treatment for fasciitis cases with inflammation while PRP is better for fasciosis cases with scar tissue and no inflammation, according to Dr. Baravarian, the Chief of Podiatric Foot and Ankle Surgery at the Santa Monica UCLA Medical Center and Orthopedic Hospital, and the Director of the University Foot and Ankle Institute in Los Angeles.
How do patients tolerate PRP injections? Dr. Baravarian finds that they usually have an inflammatory reaction and some early pain for a day. He restricts the use of ice and anti-inflammatories but otherwise says patients can stretch and take Tylenol. Usually, he says pain resolves and improvement starts at three to five days with resolution at three or four weeks.
One would draw the patient’s blood in the office with little discomfort, says Dr. Soomekh. With the administration of local anesthesia at the posterior tibial nerve, the injection is much less painful, according to Dr. Soomekh. He does concede though that most patents will still complain of a deep, achy discomfort during the injection. Dr. Soomekh says patients will have some increased pain over two to seven days, which is tolerable, and he notes that patients can use rescue medications as needed.
For further reading, see “Platelet-Rich Plasma: Can It Have An Impact For Plantar Fasciitis?” in the November 2012 issue of Podiatry Today.
Kent State Welcomes New Dean Of Podiatric Medicine
By Brian McCurdy, Senior Editor
On July 1, Allan Boike, DPM, FACFAS, will take over as the new Dean of the Kent State University College of Podiatric Medicine.