Evidence for Plantar Fasciitis

Evidence for Plantar Fasciitis

A 2014 study performed by Monto et al, randomised patients with chronic plantar fasciitis to either receive an injection of PRP or corticosteroid (1). The findings were published in Foot and Ankle international, demonstrating that PRP was more effective and durable than cortisone injections for the treatment of chronic plantar fasciitis. The effects of the PRP remained excellent at 2 years whereas the group that had been injected with the corticosteroid returned to their baseline scores at 1 year.

Similar clinical findings were observed by Shetty et al (2). In a group of patients who had failed all other treatment modalities, the PRP demonstrated promising results after injection. This debilitating condition treated with PRP, could form an attractive option in the management of chronic recalcitrant plantar fasciitis.

A meta-analysis looking at the various treatment modalities for plantar fasciitis was published in 2014 in the Rheumatology journal (3). Hsiao et al looked at the existing literature and evidence to identify which treatment modality was most effective in the plantar fasciitis. The options included injections of corticosteroid or PRP and Shock wave therapy. The study concluded that PRP was more effective than corticosteroids in providing pain relief at 3 months. Shockwave therapy and PRP had similar probabilities in providing pain relief at 6 months.

 

These findings have been supported by Jain and Say et al but go further in determining the length of time for the treatment effect (4,5). This study looked at comparing 60 patients with failed treatment of plantar fasciitis were compared using either corticosteroid or PRP. Which both groups gained symptomatic relief, the group who underwent PRP injection, continued to have symptomatic relief at 12 months, whereas the corticosteroid effect had worn off.

Shockwave therapy has been of significant interest recently in managing plantar fasciitis. A randomised trial comparing PRP injection with Shockwave therapy was performed by Chew et al in 2013 (6). They found that both treatment modalities resulted in reduced pain and improved functional outcome when compared with conventional treatment modalities. The only difference noted was that there was a greater reduction in the plantar fascia thickness in the PRP group compared to those who underwent shockwave therapy.

  1. Monto RR. Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis. Foot Ankle Int. 2014 Apr;35(4):313–8.
  2. Shetty VD, Dhillon M, Hegde C, Jagtap P, Shetty S. A study to compare the efficacy of corticosteroid therapy with platelet-rich plasma therapy in recalcitrant plantar fasciitis: a preliminary report. Foot Ankle Surg. 2014 Mar;20(1):10–3.
  3. Hsiao M-Y, Hung C-Y, Chang K-V, Chien K-L, Tu Y-K, Wang T-G. Comparative effectiveness of autologous blood-derived products, shock-wave therapy and corticosteroids for treatment of plantar fasciitis: a network meta-analysis. Rheumatology. 2015 Aug 14;54(9):1735–43.
  4. Jain K, Murphy PN, Clough TM. Platelet rich plasma versus corticosteroid injection for plantar fasciitis: A comparative study. Foot (Edinb). 2015 Dec;25(4):235–7.
  5. Say F, Gürler D, İnkaya E, Bülbül M. Comparison of platelet-rich plasma and steroid injection in the treatment of plantar fasciitis. Acta Orthop Traumatol Turc. 2014;48(6):667–72.
  6. Chew KTL, Leong D, Lin CY, Lim KK, Tan B. Comparison of autologous conditioned plasma injection, extracorporeal shockwave therapy, and conventional treatment for plantar fasciitis: a randomized trial. PM R. 2013 Dec;5(12):1035–43.