Autologous Blood Injection With Dry-Needling vs Dry-Needling Alone Treatment for Chronic Plantar Fasciitis: A Randomized Controlled Trial

Abstract

Background: Autologous blood injection (ABI) for patients with chronic plantar fasciitis has been promoted as an approach to improve outcomes over standard dry-needling approaches. The purpose of this trial was to investigate if there are improved outcomes following an ultrasonography-guided ABI compared to dry needling alone for patients with chronic plantar fasciitis. Methods: A double-blinded (participant-blinded and observer-blinded) RCT within a single clinic enrolled 90 patients with symptoms of plantar fasciitis that had failed to improve with a minimum of 3 months of rehabilitation. The mean age was 49.5±8.9 years, 67% were female, and the mean symptom duration was 40.0±28.2 months (range: 8 months–10 years). Participants were randomized to receive ABI or an identical dry-needle fenestration-procedure without coadministration of autologous blood. All participants received identical structured rehabilitation and were followed up at 2, 6, 12, and 26 weeks. Outcome measures included local foot pain, validated foot patient-reported outcome measures (Foot Function Index–revised, Manchester-Oxford Foot Questionnaire, Foot and Ankle Ability Measure), measures of general function and “ability” (EuroQol [EQ]-5D-5L, Oswestry Disability Index), specific measures of activity (International Physical Activity Questionnaire), sleep (Pittsburgh Sleep Quality Index), and mood (Hospital Anxiety and Depression Scale). Results: There were no significant between-group differences seen at any time-point studied. There were a number of statistically significant within-group improvements for local foot pain and function in both groups comparing baseline/follow-up data. Overall, levels of pain improved by 25% by 6 weeks and by 50% at 6 months. There were improvements in some generalized function markers. Activity rates did not change, demonstrating that improvements in pain did not necessarily influence physical activity. Conclusion: Coadministration of 3 mL of autologous blood had no additional effect compared to a dry-needling procedure alone for patients with chronic plantar fasciitis. Level of Evidence: Level I, double-blinded randomized controlled trial.

Platelet-Rich Plasma vs Autologous Blood Injection to Treat Plantar Fasciitis: A Prospective Randomized, Double-Blinded, Controlled Trial

“…35 However, retrospective comparative studies showed no statistically significant difference was found between ABI and other treatment methods (ie, dry needling or extracorporeal shock-wave therapy) in terms of pain and functionality in the treatment of PF. 36,37 In the comparison of CS and ABI, similar efficacy was demonstrated in the long term, but the onset of CS effect was observed earlier, as in the comparison of CS with PRP. 16,19,33 To date, in the only study comparing PRP and ABI in the treatment of PF, no significant difference was found between the 2 methods in terms of pain and function.…”

“…4,12,20,26,27,29,32 Retrospective cohort analyses and histologic studies have shown that different tendon injuries heal with the ABI method. 5,16,19,30,[33][34][35][36][37] It has been suggested that the therapeutic efficacy of ABI is similar to PRP-like regenerative efficacy. Wheeler reported long-term the effectiveness of ABI in the treatment of PF.…”