Point-Counterpoint: Is PRP Beneficial For Chronic Plantar Fasciitis?

Author(s): 
Babak Baravarian, DPM, FACFAS, and Lindsay Mae Chandler, DPM; Patrick DeHeer, DPM, FACFAS

References
1. Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med 2006; 10(10):1-5.
2. Sampson S, et al. Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med 2008; 1(3):165-174.
3. Marx RE. Platelet-rich plasma (PRP): What is PRP and what is not PRP? Implant Dent 2001; 10(4):225-228.
4. Ragab EM, Othman AM. Platelets rich plasma for treatment of chronic plantar fasciitis. Arch Orthop Trauma Surg 2012; 132(8):1065-70.
5. Barrett S, Erredge S. Growth factors for chronic plantar fasciitis. Podiatry Today 2004; 17(11):37-42.
6. Aksahin E, Dogruyol D, Yuksel HY, Hapa O, Dogan O, Celedi L, Bicimoglu A. The comparison of the effect of corticosteroids and platelet-rich plasma (PRP) for the treatment of plantar fasciitis. Arch Orthop Trauma Surg 2012; 132(6):781-5.

   For further reading, see “Platelet-Rich Plasma: Can It Have An Impact For Plantar Fasciitis?” in the November 2012 issue of Podiatry Today.

No.

This author says PRP is not the “magic bullet” it might appear to be for plantar fasciitis, emphasizing that physicians must have a strong grasp of biomechanics and equinus to treat the condition.

By Patrick DeHeer, DPM, FACFAS

The allure of a magic bullet for the treatment of any pathology, the simple solution for a complex problem, is intoxicating. The reality is this magic bullet simply does not exist. We want it to be true so badly but with time, evidence-based medicine often pulls back the curtain to reveal the “wizard” is in fact just a hoax at worst and a marginal treatment option at best.

   This is in fact the case with platelet-rich plasma (PRP) and the treatment of plantar fasciitis. The success of fibroblast-derived dermal substitutes is based on the premise that there are living dermal fibroblasts seeded on to a scaffold, which one then applies to the wound. These living dermal fibroblasts are able to secrete growth factors, deposit matrix proteins and facilitate epithelial cell migration.

   Plantar fasciitis is the most common foot pathology we as caregivers of the foot and ankle treat. The literature is damning for this not-so magic bullet of PRP and I believe that PRP is not the answer for plantar fasciitis.

   The article that has done the most damage to the magic bullet of PRP for plantar fasciitis was by Lee and colleagues in Foot and Ankle International in 2007.1 Their randomized study compared two treatments, PRP and corticosteroids, over a period of one year for patients who met the inclusion criteria of having plantar fasciitis for a period of at least six weeks with maximal tenderness over the medial plantar calcaneal tubercle. Both groups received the same volume of injections and 1% lidocaine HCl (PRP 1.5 mL mixed with 1 mL of lidocaine, or triamcinolone acetonide 0.5 mL with 2 mL of lidocaine). The total number of patients in the study was 61 with blinded follow-up visits at six weeks, three months and six months. Researchers measured the outcomes by the visual analog scale (VAS) (subjective exam) and a pressure algometer to measure tender threshold (objective exam).

   The results showed a baseline measurement of the VAS for the PRP group of 7.3 ± 1.8 initially, which decreased to 3.6 ± 2.6 at six months post-injection.1 Results in the steroid group were 6.9 ± 1.7 initially, which decreased to 2.4 ± 3.0 at six months post-injection. The tender threshold results (higher number is a better result) initially for the PRP group was 3.1 ± 1.2, which increased to 6.5 ± 2.9 at six months post-injection. For the steroid group, the initial measurement was 3.7 ± 2.0, which increased to 8.6 ± 3.1 at six months post-injection. Although all patients found both injections painful, there were no complications in either group. The conclusion from this article was “Intralesional autologous blood injection is efficacious in lowering pain and tenderness in chronic plantar fasciitis, but corticosteroid is more superior in terms of speed and probably extent of improvement.”1

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