Platelet-Rich Plasma: Can It Have An Impact For Plantar Fasciitis?
Platelet rich plasma (PRP) has been in use for decades in various medical disciplines and recently has shown some promise in treating heel pain. This author discusses how PRP fits into his treatment regimen for chronic plantar fasciitis and offers a detailed guide to collecting and injecting PRP.
Plantar fasciitis is a very common condition of the heel. It is the most commonly diagnosed cause of heel pain and will affect about 1 million people each year.1 Plantar fasciitis has received a great deal of study over several decades. Most of these studies have focused on simplifying the diagnosis and the treatment of the disease. Over the years, we have learned much to narrow down the condition’s etiology and the treatment options that work best. The goal has always been to diagnose the problem properly and quickly return patients to daily life and activity.
Researchers have identified many conservative treatments for plantar fasciitis. Ninety percent of patients with plantar fasciitis will improve with conservative treatments.1 I have adopted a diagnosis and treatment protocol that depends on the acute or chronic and recalcitrant nature of plantar fasciitis. When a patient presents with heel pain lasting less than four to six months, I will implement protocol “A.” I will use protocol “B” for those with heel pain lasting more than four to six months.
When I suspect plantar fasciitis, after taking a complete history, the clinical examination will consist of a thorough neurological and musculoskeletal examination. This rules out any other less common causes of heel pain like tarsal tunnel syndrome. I obtain plain radiographs of bilateral heels. It is important to compare the radiograph with the contralateral heel to help rule out other pathologies. Evidence of a plantar calcaneal spur should only help the clinician determine the chronicity of the tightness of the ligament unless the spur is fractured. An ultrasound examination determines the thickness of the ligament. A measurement above 5 mm is considered pathologic. When I am satisfied that the diagnosis is plantar fasciitis and the pain has been present less than four to six months, I implement protocol A.
A Closer Look At The Author’s Treatment Protocols
Protocol A. The patient will begin a strict two-week regimen including the following: rest from increased activity and an icing program of 10 to 15 minutes per treatment two to three times a day. The patient begins using an anti-inflammatory consistently for 10 to 14 days. I educate the patient on the extensive stretching program involving stretches of the calf and plantar fascia. Stretches before weightbearing out of bed or from long periods of rest are especially important. I educate patients on the use of appropriate shoe gear and advise them not to be barefoot or use sandals or flats even in the home. I also advise patients on the benefits of custom-molded orthotics in the treatment and prevention of plantar fasciitis. I recommend a cortisone injection at the initial visit in cases in which there is significant acute pain with weightbearing.
The patient returns in two weeks for re-evaluation. At this time, if there is improvement, the treatment continues. If there is no improvement or the condition is worse, I recommend a cortisone injection along with a four- to six-week course of physical therapy. If these conservative measures fail, use protocol B.
Protocol B. After four to six months of failed treatment or no treatment, one may consider the condition to be more chronic than acute. In these circumstances, order a magnetic resonance image (MRI) to evaluate the soft tissue and bone around the heel. In some cases, the MRI may reveal no pathology and no evidence of plantar fasciitis. When all other clinical and examination findings still point to a diagnosis of plantar fasciitis, it could still be present in the absence of MRI findings. This may be due to the lack of inflammation in a more chronic state that will not show on an MRI.