Point-Counterpoint: Is PRP Beneficial For Chronic Plantar Fasciitis?
Mishra and Pavelko evaluated 20 patients with chronic severe elbow tendinosis who had persistent pain for a mean of 15 months despite nonoperative treatments and were considering surgical intervention.1 The patients received either a single percutaneous injection of PRP or bupivacaine. After eight weeks of treatment, their results showed 60 percent improvement in the visual analog scale pain scores for the PRP patients versus 16 percent improvement for the bupivacaine patients. They concluded treatment with PRP reduced pain significantly in patients with chronic elbow tendinosis and one should consider PRP before surgical intervention.
A Closer Look At The Authors’ Treatment Protocol
After six months of failed treatment or no treatment for plantar fasciitis, we deem the condition to be more chronic than acute. At this point, we present the patient with the option of performing more aggressive yet still non-invasive therapies. Our objective at that point is to stimulate an inflammation process at the insertion of the plantar fascia. The therapies we offer include: ESWT, monopolar capacitive-coupled radiofrequency, Coblation and PRP injections.
The PRP injection occurs in the office. We begin by collecting the blood from the patient’s cubital vein. A centrifuge separates the platelets from the plasma, which can take five to 20 minutes depending on the speed of the centrifuge and the concentration desired.
We inject local anesthetic into the surrounding skin, soft tissue and fascia. With ultrasound guidance, we advance the needle within the fascia. Using a peppering technique, we inject the growth factors over the entire region, traumatizing the fascia to some extent to allow the inflammatory response to increase.
Following injection, the patient wears a controlled ankle motion (CAM) walker boot to provide support and decrease stress on the plantar fascia. The patient wears the boot for two weeks while weightbearing as tolerated and then transitions into a stability/motion control running shoe, preferably with custom orthotics. The patient also receives instructions not to ice the area or take any non-steroidal anti-inflammatory drugs for the first two to three weeks post-injection.
At the University Foot and Ankle Institute, we have seen promising results with the use of PRP in plantar fasciosis for decreasing pain, improving function, increasing activity and decreasing recovery time. In our institute, we have found that 80 percent of patients with plantar fasciosis improve to the point of having minimal to no pain following two consecutive PRP injections spaced one month apart in comparison to 50 percent improvement following the primary injection. Therefore, we advise our patients on the benefits of a second injection if the first yields only partial relief of symptoms.
We have concluded PRP therapy to be an excellent as well as a non-invasive measure for the treatment of plantar fasciosis, preventing many of our patients from progressing to further surgical treatment post-injection.
Dr. Baravarian is an Assistant Clinical Professor at the UCLA School of Medicine. He is the Chief of Podiatric Foot and Ankle Surgery at the Santa Monica UCLA Medical Center and Orthopedic Hospital, and is the Director of the University Foot and Ankle Institute in Los Angeles. He is a Fellow of the American College of Foot and Ankle Surgeons.
Dr. Chandler is a Fellow at the University Foot and Ankle Institute in Los Angeles.