Autologous platelet-rich plasma compared with whole blood for the treatment of chronic plantar fasciitis; a comparative clinical trial

Abstract

Background:Intralesional injection of autologous blood-derived products has recently gained attention as a potential treatment for plantar fasciitis (PF). We compared platelet-rich plasma (PRP) and whole blood (WB) for the treatment of chronic PF.Materials and Methods:Patients with chronic PF received either an intralesional injection of 3 cc PRP prepared by double centrifuge technique or WB (n = 17 in each group). Overall, morning and walking pain severity were assessed by 11-point numerical rating scale, and function was assessed by the Roles and Maudsley score (RMS) at baseline and 1-month and 3 months after treatment. Ultrasonography was performed to measure plantar fascia thickness at baseline and 3 months after treatment.Results:Pain scores were reduced over the study in the PRP (mean change = −5.00 ± 1.17 to −5.47 ± 1.46) and WB groups (mean change = −5.29 ± 2.56 to −6.47 ± 2.83), with no difference between groups (P > 0.05). One month and 3 months after treatment, successful treatment (RMS of ≤ 2) was respectively observed in 29.4% and 82.3% of the PRP and in 47.1% and 76.4% of the WB groups (P > 0.05). Also, fascia thickness was decreased in both the PRP and WB groups (mean change = −1.74 ± 1.11 vs. −1.21 ± 0.73 mm, respectively, P = 0.115).Conclusions:Significant improvement in pain and function, as well as decrease in plantar fascia thickness, was observed by intralesional injection of the PRP and WB in patients with chronic PF. The study results indicate similar effectiveness between PRP and WB for the treatment of chronic PF in short-term.

Effects of platelet-rich plasma in the treatment of plantar fasciitis

“…Three studies reported the data of RMS. [ 21 , 23 , 26 ] Pooled estimate suggested that, PRP had a comparable effect with other treatments in the change from baseline in RMS (WMD = −0.34, 95% CI: −1.04, 0.35; P = .334) (Fig. 5 ).…”

“…The sample size of these studies ranged from 28 to 60 (total 445, 128 males and 317 females). Among the included studies, 2 were conducted in India, [ 22 , 24 ] 2 in Iran [ 23 , 26 ] and Egypt, [ 29 , 30 ] each one in UK, [ 21 ] Mexio, [ 25 ] Turkey, [ 27 ] and USA. [ 28 ] Nine trials compared the effects of PRP with steroid, [ 21 , 22 , 24 , 25 , 27 – 30 ] and one compared PRP with whole blood.…”

“…[ 28 ] Nine trials compared the effects of PRP with steroid, [ 21 , 22 , 24 , 25 , 27 – 30 ] and one compared PRP with whole blood. [ 23 ] In the study conducted by Mahindra et al, [ 26 ] patients with plantar fasciitis were randomly assigned to the local PRP, corticosteroid, or placebo groups. Since the data for changes in VAS and AOFAS scores were presented in all the 3 arms, we included these data in this meta-analysis.…”

“…Overall, 4 trials were categorized as being at low risk of bias, [ 22 , 25 , 26 , 30 ] and the remaining 6 as being at unclear risk of bias. [ 21 , 23 , 24 , 27 – 29 ] The main reasons for the trials being at unclear risk of bias were that, they did not adequately describe the methods for randomized sequence, allocation sequence concealment, blinding of participants/ persons, and outcome assessment.…”

Low-Dose Radiotherapy of Painful Heel Spur/Plantar Fasciitis as an Example of Treatment Effects in Benign Diseases

“…A recent review identified three randomized trials, all showing promising results [78]. However, a very small trial challenged this method of plasma preparation, as the same clinical effectivity was observed after the injection of whole blood [79]. Different surgical approaches have been developed.…”