This short article will look at PRP injections as a treatment for plantar fasciitis.
Rationale
Platelet Rich Plasma (PRP) injections are a relatively new treatment that involves taking a patient’s own blood (usually from the arm) and placing the blood into a special machine (centrifuge) to separate different components of the blood. This allows the clinician to use concentrated levels of platelets and growth factors found in the blood sample which is then injected at the site of injury to promote healing in injured plantar fascia tissue. Regarding the way in which PRP works, some laboratory studies have demonstrated that the increased concentration of growth factors in PRP are able to augment the body’s natural healing process
Evidence
A recent level 1 study (high quality) compared PRP injections with corticosteroid injections. Both treatments demonstrated good results at 3 months however the corticosteroid group returned to baseline levels of pain at 12 months whilst the PRP still demonstrated significant pain relief at 12 months and also at 24 months following treatment (Monto 2014). There are a number of other recent studies which have demonstrated PRP to be superior to corticosteroid injections (Shetty et al 2014; Akashin et al 2012).
A systematic review is a method of pulling together all the current research to draw an overall conclusion. The quality of the studies and the methods within each study can vary widely which can reduce the overall meanfulness of the systematic review. Nonetheless, it does give one an overall balanced view. Below is a conclusion from a recent systematic review (Franceschi et al 2014).
"Evidence for the use of PRP in PF shows promising results, and this therapy appears safe. However, the number of studies available is limited and randomized placebo-controlled studies are required. Characterizing the details of the intervention and standardizing the outcome scores would help to better document the responses and optimize the treatment."
A more recent research paper conducted a meta-analysis, this is where researches pull together the combined results of individual research studies to give an overall picture. The meta-analysis looked at 9 randomised control trials (good quality research) and included 430 patients. Each individual study compared PRP injections with steroid injections. Overall the meta-analysis found that there were no significant differences between the two groups at 4 and 12 weeks after treatment, however there was a small difference at 24 weeks with the PRP group achieving better pain improvement scores compared with the steroid group (Yan et al 2017).
Risks
PRP is not generally considered to have any major harmful effects because apart from a patient’s own blood, no other constituents are added to the injection. For that reason, it is popular with patients who want more of a ‘natural approach’ to dealing with their injuries. There is a small risk of infection as with any injection therapy.
Verdict
The theory behind PRP injection therapy makes this an attractive treatment option for chronic plantar fasciitis that has not responded to usual conservative treatment. There is a lack of high-quality evidence at this stage to be sure on the true efficacy of this treatment option. For now, this remains a 'watch this space' treatment and certainly an option worth considering before surgical intervention as it is less invasive and comes with minimal risks.
Thanks for reading. Comments welcome.
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