Platelet-Rich Plasma: Can It Have An Impact For Plantar Fasciitis?
When I am confident in the diagnosis of plantar fasciitis, I present the patient with the option of performing more aggressive therapies: extracorporeal shockwave therapy (ESWT), platelet rich plasma (PRP) injection or Topaz Coblation (Arthrocare). I most often choose PRP.
Examining The Evolution And Theoretical Benefits Of PRP
The use of orthobiologics in the treatment of foot and ankle injuries, both in the clinical and surgical venues, is significantly increasing. The clinician and the surgeon continue to seek better ways to accelerate and mediate healing of bone and soft tissue while incorporating less invasive techniques.
The use of autologous PRP by foot and ankle specialists over the last few years has emerged in the forefront of biologic tools in this endeavor. Over the last four decades, researchers have looked at PRP for the treatment of tendon injuries, chronic wounds, ligamentous injuries, cartilage injuries, muscle injuries and bone augmentation (intraoperative fusions and fracture repair). There have been several studies investigating the efficacy of PRP and its applications.2 It has been in wide usage in the areas of spine surgery, wound healing, plastic surgery, oral and maxillofacial surgery, and orthopedic and podiatric surgery.2
The theory behind using PRP is that increased concentrations of autologous platelets, which yield high concentrations of growth factors and other proteins, will lead to enhanced healing of bone and soft tissue on a cellular level.
Platelet rich plasma is the concentration of platelets derived from the plasma portion of centrifuged or filtered autologous blood. This platelet rich solution can be an adjunct to healing, as in a fresh surgical fusion, or can reinstate healing as in the case of chronic tendon injuries. Platelet rich plasma and related products have different labels throughout the literature including: platelet-rich concentrate, platelet gel, preparation rich in growth factors (PRGF), platelet releasate and platelet-leukocyte-rich gel (PLRG).
Acquired PRP may or may not be activated by another product. Usually, we reserve PRP without activation for the treatment of tendons, muscles and other soft tissues. Platelet rich plasma activated into a gel or fibrin sealant is for use clinically and intraoperatively for tendon augmentation, wound healing and bone augmentation.
Essentially, PRP increases the concentration of platelets to an injured site. In an acute injury, platelets normally activate during the inflammatory phase to begin healing. The addition of PRP in the acute injury increases the concentration of platelets at the local tissue above the baseline. Chronic injuries that have failed conservative therapies presumably have ceased the inflammatory phase, have a paucity of platelets and a decrease in healing potential.
In these situations, PRP would provide two beneficial results. First, the simple act of the application of PRP through injection for tendon, ligament or muscle injuries will stimulate the tissue and restart the inflammatory process. This makes the chronic injury into a “new” acute injury. Second, the addition of autologous concentrations of platelets theoretically augments the healing process. This new injury now has a known starting point and one can place it in a controlled, post-injection environment (e.g. immobilization, bracing or non-weightbearing). During this time, restrict the use of anti-inflammatory medications and therapies so as not to reverse the desired effect.