Point-Counterpoint: Is PRP Beneficial For Chronic Plantar Fasciitis?
Aksahin and coworkers demonstrated similar outcomes in 2012.2 These authors concluded the following: “In this study, the effects of the corticosteroid and PRP injection in patients with plantar fasciitis were analyzed with clinical evaluation methods. Taking the possible regenerative effect of PRP into consideration, the results of the PRP injection group were expected to be more satisfactory in cases of plantar fasciitis since it is believed to be a regenerative process rather than an inflammatory reaction.”
This study did discuss “potential” complications associated with steroid injections and that PRP injections are safer with similar outcomes.2 The authors did not discuss the cost of the procedure and overstate the complications of steroid injections, given the corresponding literature, which Aksahin and coworkers note shows relatively rare complications associated with steroid injections for plantar fasciitis.
Emphasizing The Multifactorial Nature Of Plantar Fasciitis
When evaluating the results of these studies, the question we must ask is: Is there is a role for PRP in the treatment of plantar fasciitis? Secondly, what role does the cost of PRP and blood draw and handling of the specimen play in the decision making process? In my opinion, the role of PRP alone in the treatment of plantar fasciitis is negligible.
I believe the reason for the outcome of this study is that plantar fasciitis is a multifactorial condition.2 Regardless of whether you think this an inflammatory versus a degenerative process, ignoring the biomechanical etiologies such as pronation syndrome, cavus deformity and equinus will not lead to consistent favorable outcomes. If there is an inflammatory condition, the reduction of the inflammation is critical to the successful treatment of plantar fasciitis. If there is progression into a degenerative process, the outcomes of this study indicate that, although the authors did not differentiate the acute inflammatory versus degenerative process, steroid injections are more efficacious than PRP injections.
The literature is replete with evidence-based medicine on the importance of equinus in the management of plantar fasciitis.3-10 Specifically, Digiovanni and colleagues say the tissue-specific plantar fascia stretching protocol for chronic plantar fasciitis can provide a long-term decrease in pain.3 Any treatment plan without equinus management when indicated by the diagnosis of equinus is an incomplete plan and the patient suffers.
There are similar findings regarding the role of biomechanical control in the treatment of plantar fasciitis.11-18 Fong and coworkers found a beneficial effect by combining rocker bottom soles and custom orthoses for patients with plantar fasciitis.11 Rome and colleagues found that for patients with plantar foot pain, orthoses provided a significant decrease in pain at four weeks.15
The literature has demonstrated the PRP magic bullet to be at best an adjunctive treatment alternative to established treatment protocols for plantar fasciitis. The treatment of plantar fasciitis is based on an accurate diagnosis derived from the patient history and physical examination. One must implement all components of treatment in a coordinated, well-structured treatment plan. At worst, the use of PRP injections for plantar fasciitis is an expensive, somewhat labor-intensive, marginally effective procedure.
Please do not be seduced by the glamor of this false magic bullet. Instead, trust in your knowledge base of podiatric medicine, specifically biomechanics, in the treatment of the most common foot and ankle pathology.
Dr. DeHeer is a Fellow of the American College of Foot and Ankle Surgeons, and a Diplomate of the American Board of Podiatric Surgery. He is in private practice in Indianapolis.