Platelet-Rich Plasma: Can It Have An Impact For Plantar Fasciitis?
A Guide To Acquiring And Utilizing PRP
To acquire autologous PRP, collect blood from the cubital vein. Determine the amount of blood acquired by the clinical application (treatment area) and desired concentration. Then separate the platelets from the plasma by means of centrifugation or filtration. Many different systems are available on the market today to obtain the PRP.
When using a simple centrifugation process, the collected blood spins down between five and 20 minutes, depending on the speed of the centrifuge and the concentration desired. There will be three relative layers of product in the tube: the plasma layer (platelets); the buffy coat layer (white blood cells); and the remaining blood products (red blood cells). The platelets are at the top of the tube. (There has been debate on the true concentrations obtained through simple centrifugation and the true output of a platelet-rich versus a platelet-poor product.) Then one collects the PRP from the tube using a syringe and 18-gauge needle, being careful not to collect any platelet-poor or red blood cells.
A similar method of collection uses an automated centrifugation process that separates the platelets from the whole blood and then automatically sends the product to a separate syringe using an infrared microprocessing sensor to differentiate between red blood cells and platelet-rich plasma. This type of system seems to lead to more accuracy and allows for more reproducible concentrations. There is presumably less error with less manual manipulation of the blood product through automated separation. One such device is the Magellan Autologous Platelet Separator System (Arteriocyte Medical Systems).
With either method, the tube that initially collected the blood must have an anticoagulant. The kits that come with the products usually already have tubes with anticoagulant or will come with a separate anticoagulant.
What The Research Reveals On PRP For Plantar Fasciitis
There have been limited studies examining the efficacy of PRP in the treatment of plantar fasciitis.
Barrett and Erredge investigated the use of PRP for plantar fasciitis in a small study.3 They used ultrasound of the fascia before and after treatment, and a patient pain scale to help determine efficacy. The patients were weightbearing in a walking boot for two days and then wore regular shoe gear with limited activity. They were restricted from using anti-inflammatories or other modalities. Researchers found that six of nine patients achieved complete resolution of symptoms after two months. One patient had resolution after a second injection. After one year, 77.9 percent of the patients had no symptoms. The study showed that ultrasound measurements of the thickness of the plantar fascia reduced following injection. It is unclear how long the study patients had their symptoms before treatment.
In a prospective work, Ragab and Othman looked at 25 patients with chronic plantar fasciitis who were treated with PRP.4 Over a mean follow-up period of 10.3 months, they found patients’ pain decreased from an average 9.1 to 1.6 on the Visual Analogue Scale after the injection with 88 percent of the patients completely satisfied and 60 percent with no functional limitations. They concluded that PRP is a safe and satisfactory method of treating plantar fasciitis.
Akşahin and colleagues compared the effectiveness of PRP injection versus corticosteroid injection for chronic plantar fasciitis.5 They studied 30 patients treated with PRP and 30 treated with steroids. Over a period of six months, they found that both patient groups had significant improvement in symptoms but there was no statistical difference between the groups. Taking into consideration the increased potential of complications with corticosteroid injection, the authors felt PRP to be safer and, at least, has the same effectivness as corticosteroid use for plantar fasciitis.