Platelet Rich Plasma: Can It Have An Impact For Tendinosis And Plantar Fasciosis?

Babak Baravarian, DPM

   The use of platelet rich plasma (PRP) injections in the treatment of fasciosis and tendinosis about the foot and ankle is a fairly recent and evolving concept. The idea behind such injections is quite simple and has been well studied in the literature.

   The concept is that there is a loss of inflammatory response and chronic scar formation with fascia and tendon injuries. The proper terms for such injuries are fasciosis and tendinosis rather than the more commonly used terms of fasciitis and tendonitis. In fasciitis and tendonitis cases, there is good blood supply to the problematic region but there is an inflammatory response that is painful. In fasciosis and tendinosis issues, the fascia and ligament have a decrease in inflammatory response, a reduction in the growth/healing factors and a chronic scar formation that prevents the healing process.

   It is ironic that we usually try to treat such issues on the acute (fasciitis/tendonitis) cases with rest while we try to treat the chronic issues (fasciosis/tendinosis) with cortisone injections. This does not make sense as an anti-inflammatory injection such as cortisone has a better chance of working in the acute phase when there is still an inflammatory process that is working.

   With chronic injuries such as Achilles tendinosis and plantar fasciosis, cortisone injections do not help very much. There is no inflammatory process with these injuries and the injection only works via the trauma caused by the needle, resulting in an inflammatory response in the designated area.

   Alternatively, platelet rich plasma injections are very useful in chronic injury cases as they restart and stimulate the inflammatory cascade, which enhances the healing process. Again, an injection without control of the underlying cause of injury will not result in as good an outcome as post-injection support and a decrease in the cause of the problem.

   For example, in a plantar fasciitis case, it is better to give an injection of cortisone during the first or second visit if the patient is not responding to conservative care such as stretching, icing and therapeutic exercises. However, when a patient has had plantar fascia pain for six months and there is a great deal of scar formation, a cortisone injection is of far less relevance than a platelet rich plasma injection to restart the inflammatory and healing cascade.

   In regard to platelet rich plasma injections, patients with plantar fasciitis for six months should wear a boot for the first two weeks after injection. This allows the fascia time to heal without chronic tension and allows the growth factors to work without continued trauma.

How Platelet Rich Plasma Jump-Starts The Healing Process

   Histologic samples from chronic tendinosis and fasciosis cases have shown no inflammatory response. What researchers have shown is a limitation of the normal tendon repair system with a fibroblastic and vascular response, known as angiofibroblastic degeneration.1-3 The traditional treatment options such as cortisone have relied on a decrease in the inflammatory process.

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