Effect of Ultrasound-Guided Injection of Local Ozone or Platelet Rich Plasma Versus Corticosteroid in Plantar Fasciitis

Abstract

Background : Plantar fasciitis or recently called plantar fasciopathy, generally observed with heel spurs because of the deposition of calcium, although the definite pathology is still unknown. Ultrasound-guided injection of conventional corticosteroids was the primary treatment modality, with other emerging substances (e.g. Ozone or Platelet Rich Plasma PRP). Aim of the study: This study was conducted to evaluate the effect of ultrasound-guided injection of local Ozone or Platelet Rich Plasma (PRP) versus conventional corticosteroid in the management of plantar fasciitis. Patient and methods: this a randomized Prospective comparative study has done Al-Azhar university hospitals (Al-Hussein and Sayed Galal), where fifty-one patients have been diagnosed to have plantar fasciitis were included and allocated into one of three groups (17 patients in each group) to receive an ultrasound-guided injection of corticosteroid (control group), platelet-rich plasma (PRP) or Ozone O2-O3. Clinical evaluation and ultrasonographic measurement of the plantar fascia thickness was done before, at one, three and six months next to the injection. Primary outcome included: pain score using the visual analogue score (VAS). While secondary outcomes were plantar fascia thickness and foot quality health status. Results: There was a highly significant decrease in VAS score and plantar fascia thickness, and an increase in foot pain domain of the foot health status (FHSQ) score in corticosteroid and Ozone groups (p < 0.01 respectively) in one month. Regarding 3-month results, there was a highly significant decrease in VAS score plantar fascia thickness, and an increase in FHSQ score in the corticosteroid group (p < 0.01 respectively). Regarding long-term 6-month results, there was a highly significant decrease in VAS score, plantar fascia thickness, and an increase in FHSQ score in the PRP group (p < 0.01 respectively). Conclusion:Corticosteroid and Ozone injections were effective at shortterm assessment, but PRP was more valuable at long-term assessment regarding pain management in plantar fasciitis patients.

Ultrasound-guided injection of corticosteroid versus placebo in management of plantar fasciitis

“…9,10 Corticosteroids (CS) are the primary injection for PF, offering low cost, simplicity, and fast pain relief. Despite potent anti-inflammatory effects, they pose risks of plantar fascia rupture and fat pad atrophy 11 A randomized controlled trial compared the effects of a 25 mg hydrocortisone injection to a placebo (normal saline), revealing no significant difference in pain reduction between the groups two months after treatment. However, the trial's small sample size (19 participants) made it statistically underpowered to detect clinically meaningful distinctions.…”

Objective assessment of Platelet‐Rich Plasma (PRP) potentiality in the treatment of Chronic leg Ulcer: RCT on 80 patients with Venous ulcer

“…GFs provoke angiogenesis, chemo taxis, cellular proliferation, and wound remodeling. [5][6][7][8] More evidence is still required to assess the reliability of PRP in the treatment of chronic leg venous ulcer. This study aims to evaluate the clinical efficacy of PRP injection versus conventional methods (debridement, compression, and dressing) for the treatment of chronic VLU.…”

“…GFs include platelet‐derived growth factors (PDGF), fibroblast‐derived growth factors (FDGF), and epidermal growth factors (EGF). GFs provoke angiogenesis, chemo taxis, cellular proliferation, and wound remodeling 5‐8 …”