Chronic plantar fasciitis is a common but sometimes difficult condition to successfully treat. Platelet rich plasma (PRP), a concentrated bioactive component of autologous blood that is rich in cytokines and other growth factors, was compared with cortisone injection in the treatment of severe cases of plantar fasciitis resistant to traditional non-operative paradigms.
Thirty-six patients (16 males, 20 females) with severe chronic plantar fasciitis who had failed traditional non-operative treatment (rest, heel lifts, PT, NSAIDS, cam walker immobilization, night splinting, local modalities) were randomized into two study groups and evaluated prospectively. All patients had pre-treatment MRI and ultrasound studies consistent with plantar fasciitis. Group 1 was treated with a single ultrasound-guided injection of 40 mg methylprednisolone at the injury site and Group 2 was treated with a single ultrasound-guided injection of un-buffered autologous PRP at the injury site. All patients were then immobilized fully weight bearing in a cam walker for two weeks, started on eccentric home exercises and then allowed to return to normal activities as tolerated and without support.
Group 1 had an average age of 59 (24-74) and had failed 5.4 months (4-24) of standard non-operative management and had pre-treatment AOFAS scores of 52 (24-60). The PRP group had an average age of 51 (21-67) and had failed 5.7 months (4-26) of standard non-operative management and had pre-treatment AOFAS scores of 37 (30-56). Post-treatment AOFAS scores in Group 1 initially improved to 81 (60-90) at three months but decreased to 74 (56-85) at six months and dropped further to 58 (45-77) at 12 months follow up. Post-treatment AOFAS scores in Group 2 improved to 95 (84-90) at three months and remained excellent at 94 (87-100) at six months and stayed at 94 (86-100) at 12 months follow up (CI 95% P=0.001). No patients were lost to follow up.
DISCUSSION AND CONCLUSION
This study suggests that platelet rich plasma injection is significantly more effective and durable than cortisone injection for the treatment of severe chronic plantar fasciitis refractory to traditional non-operative management.