What is the role of Platelet-Rich Plasma (PRP) treatment for plantar fasciitis?

PRP Treatment for Plantar Fasciitis

Platelet-Rich Plasma (PRP) injections can be effective for chronic plantar fasciitis that is resistant to conservative treatment, showing superior long-term pain relief and functional outcomes compared to corticosteroid injections and other modalities. 1

Efficacy of PRP for Plantar Fasciitis

PRP has demonstrated significant benefits for plantar fasciitis treatment, particularly in cases that have failed conservative management:

• Recent meta-analysis (2024) shows PRP provides significantly greater improvements in pain scores compared to extracorporeal shock wave therapy (ESWT), corticosteroid injections, and placebo 1
• PRP demonstrates superior long-term outcomes in reducing plantar fascia thickness and improving foot function compared to other treatments 1
• Studies show PRP has regenerative effects with longer and better efficacy in pain management of chronic recalcitrant plantar fasciitis than other modalities 2

Treatment Algorithm for Plantar Fasciitis

1. First-line treatment:

   • Conservative measures (exercise therapy, stretching, orthoses)
   • If no improvement after 6 weeks, consider advanced interventions

2. For chronic/recalcitrant cases:

   • PRP injection under ultrasound guidance (2.5 ml of autologous PRP) 2
   • Therapeutic quality autologous PRP should contain approximately 1×10^6 platelets/μl 2

3. Expected outcomes:

   • Initial improvement may be slower than with corticosteroids (at 2 weeks) 2
   • Superior long-term outcomes at 3-6 months compared to other treatments 3, 2
   • Significant reduction in plantar fascia thickness by 6 months 3

Evidence for PRP Effectiveness

• A 2023 randomized controlled trial showed that while ESWT provided better short-term relief (at 15 days), PRP demonstrated superior outcomes at 90 days with greater pain reduction and functional improvement 4
• PRP injection resulted in greater reduction of plantar fascia thickness (from 5.78mm to 3.35mm) compared to other treatments 3
• Patient satisfaction rates with PRP treatment have been reported as high as 88% completely satisfied 5

Important Considerations and Limitations

• Standardization issues: The International Society on Thrombosis and Haemostasis notes significant variability in PRP preparation methods, leading to inconsistent biological properties and potential efficacy 6

• Preparation factors: For optimal results, PRP preparation should include:

  • Proper anticoagulant selection (trisodium citrate recommended, avoid EDTA) 6
  • Documentation of platelet concentration and activation status 6
  • Reporting of white blood cell and red blood cell content 6

• Contraindications:

  • Active bilateral plantar fasciitis
  • Vascular insufficiency or neuropathy related to heel pain
  • Diabetes mellitus
  • Previous surgery for plantar fasciitis 3

Safety Profile

PRP is generally considered safe as it uses the patient's own blood products, with no serious adverse effects consistently reported in studies 7. This makes it an attractive option for patients who cannot tolerate or have contraindications to other treatments.

Monitoring and Follow-up

• Evaluate response using validated tools:

  • Visual Analog Scale (VAS) for pain
  • American Orthopedic Foot and Ankle Society (AOFAS) score
  • Foot Function Index (FFI)
  • Ultrasound measurement of plantar fascia thickness 4, 3, 2

• Follow-up schedule:

  • Assess at 2 weeks, 6 weeks, 3 months, and 6 months post-injection 4, 3

While the International Society on Thrombosis and Haemostasis notes uncertainty about PRP for tendon injuries 6, more recent specific evidence supports its use for plantar fasciitis, particularly in chronic cases that have failed conservative management.