Introduction to Platelet-Rich Plasma (PRP) for Chronic Plantar Fasciitis
Plantar fasciitis is a common source of foot pain in adults, particularly in athletes, characterized by pain at the underside of the foot near the calcaneal tuberosity, where the plantar fascia originates. This condition is often a result of repetitive microtrauma rather than inflammation. Known risk factors include obesity, poor foot biomechanics, flat feet, prolonged standing, high-impact activities such as running or jumping, and poorly fitted footwear. While many patients experience resolution of pain within a year, approximately 10% develop chronic symptoms that can significantly affect daily life.
Conventional treatments for plantar fasciitis include NSAIDs, activity modifications, ice application, physical therapy, arch support, and stretching exercises. However, evidence supporting their long-term efficacy is limited. Corticosteroid injections, while providing short-term relief, are associated with significant side effects, including rupture of the plantar fascia, infections, and skin depigmentation. In contrast, platelet-rich plasma (PRP) is emerging as a promising treatment due to its ability to promote healing and tissue regeneration without the adverse effects seen with corticosteroids.
Study Overview
Kalia and colleagues (2020) conducted a prospective case series involving 30 patients with chronic plantar fasciitis lasting at least six months, who had not responded to conservative treatments. The study aimed to evaluate the effectiveness of a single PRP injection in relieving symptoms and improving functional outcomes.
Study Details:
• Participants: 30 patients (mostly women, mean age 39) with chronic plantar fasciitis.
• Procedure: A single 3 mL PRP injection using a peppering technique at the point of maximum tenderness on the heel.
• Outcome Measures: Pain scores (Visual Analog Scale, VAS), functional disability (Foot and Ankle Disability Index, FADI), and plantar fascia thickness (measured via ultrasound).
Results:
• Pain Reduction: Baseline pain scores averaged 6.5/10. By 12 weeks, pain scores dropped to 0.8/10 (87.7% improvement).
• Functional Improvement: FADI scores improved from 53.1 at baseline to 77.9 at 12 weeks, a 46.7% improvement.
• Ultrasound Findings: Plantar fascia thickness reduced from 4.9 mm at baseline to 3.9 mm at 12 weeks, showing signs of healing.
• No Adverse Effects: The PRP injection was well-tolerated, with no significant local or systemic side effects reported.
Statistical Significance:
All six- and twelve-week measurements showed statistically significant improvements, indicating that PRP is an effective treatment for chronic plantar fasciitis.
Conclusion
The study results suggest that a single PRP injection can lead to significant improvements in pain, function, and tissue healing in patients with chronic plantar fasciitis. The lack of side effects associated with PRP and its ability to promote healing at the point of injury make it a valuable treatment option, especially for patients who have not responded to conservative measures. While the study lacked a control group, the promising results support the use of PRP as an effective, long-term alternative to corticosteroid injections.
Reference:
Kalia, R. B., Singh, V., Chowdhury, N., Jain, A., Singh, S. K., & Das, L. (2020). Role of Platelet Rich Plasma in Chronic Plantar Fasciitis: A Prospective Study. Indian Journal of Orthopaedics, 55(Suppl 1), 142–148. https://doi.org/10.1007/s43465-020-00261-w
