Extracorporeal Shockwave Therapy Versus Platelet Rich Plasma Injection in Patients of Chronic Plantar Fasciitis: A Randomized Controlled Trial From a Tertiary Center of Eastern India

Abstract

IntroductionPlantar fasciitis is a degenerative condition of the plantar fascia that leads to heel and sole pain. Physical modalities, physiotherapy, medication, and orthoses have been tried before as treatments. Extracorporeal shockwave therapy (ESWT) and the injection of autologous platelet-rich plasma (PRP) are generally effective in the treatment of plantar fasciitis, which might be resistant to other conservative measures. The present study compares the efficacy of ESWT and PRP injection in respect of symptomatic relief, functional improvement, and change in plantar fascia thickness (PFT). MethodsSeventy-two patients were enrolled and randomized into two groups. Patients in the first group received ESWT, whereas patients in the second group received PRP injections. Patients were evaluated using the Visual Analog Scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) score, along with PFT measurement (using ultrasonography) before the treatment and at days 15, 30, and 90 after the treatment. The X 2 test was used to compare qualitative variables, and the paired T-test was used to evaluate quantitative data. Quantitative variables had a normal distribution with a standard deviation, and the significance level was set at P-value=0.05. ResultsOn day 0, the mean VAS of the ESWT and PRP groups were 6.44±1.11 and 6.78±1.17, respectively (p=0.237). On day 15, the mean VAS of the ESWT and PRP groups were 4.67±1.45 and 6.67±1.35, respectively (p<0.001). At day 30, the mean VAS of the ESWT and PRP groups were 4. 97±1.46 and 4.69±1.39, respectively (p=0.391). On day 90, the mean VAS of the ESWT and PRP groups were 5.47±1.63 and 3.36±0.96 (p<0.001). On day 0, the mean PFTs of the ESWT and PRP groups were 4. 73±0.40 and 5.19±0.51, respectively (p<0.001). At day 15, the mean PFT of the ESWT and PRP groups were 4.64±0.46 and 5.11±0.62, respectively (p<0.001) which changed to 4.52±0.53 and 4.40±0.58 at day 30 (p<0.001), and to 4.40±0.50 and 3.82±0.45 at day 90 (p<0.001).

Platelet-Rich Plasma vs Extracorporeal Shock Wave Therapy in the Treatment of Plantar Fasciitis at 3-6 Months: A Systematic Review and Meta-analysis of Randomized Controlled Trials

“…2,9,12,16,21,31,32,40 However, our results show that PRP was superior in reducing pain outcomes when compared with ESWT. In fact, 6 of the 7 analyzed studies 6,11,13,27,33,38 showed better pain improvement in the PRP group, with the remaining study showing no significant differences between PRP and ESWT. 36 However, one must note that this study had a high risk of bias in our study because the randomized controlled trial was not blinded.…”

“…Six randomized controlled trials met inclusion criteria and were included in this meta-analysis. 11,13,27,33,36,38 Altogether these studies included 214 subjects in the PRP group and 218 subjects in the ESWT group. The characteristics of the included studies are summarized in Table 1.…”

New Infiltration Technique in the Treatment of the Plantar Fascia Syndrome Based on Platelet-Rich Plasma

“…It is a fact that there are trials based on a single infiltration of PRP. In some of them, a 3 mL dose was used [ 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ] which is 50% more PRP than the PRP used in the trial (2 mL) presented in this paper. Other authors used larger doses, such as 4 mL of PRP [ 55 ] or even 5 mL of PRP in a single infiltration [ 56 ], which represents 150% more PRP than used in this trial.…”

“…Another aspect to stress is that before infiltrating the feet diagnosed with chronic PFS, some authors perform either a posterior tibial nerve block [ 7 , 46 ] or local anaesthesia at the infiltration site [ 7 , 47 , 51 , 57 , 58 ] and this is a totally different procedure. In this trial, there was no nerve block or anaesthesia, and the infiltration area was only sprayed with chloroethyl Chemirosa with the exclusive purpose of reducing skin sensitivity at the time of the puncture.…”

“…There are no known trials that have assessed four different pain typologies with the 10 points Visual Analogue Scale nor any studies reflecting the results of the active extension of the ankle in passive soleus and in passive gastrocnemius in patients treated with PRP. However, there are studies like this one that reflect the decreasing values of PFT in patients treated with PRP [ 48 , 51 , 53 , 54 , 55 , 60 ].…”