A Randomized Controlled Study to Evaluate the Effectiveness of Local Platelet Rich Plasma (PRP) Injection for the Management of the Cases of Planter Fasciitis - Final Outcome of 179 Cases at 12 Months

Prof S.P. S. Gill, Dr Jasveer Singh, Dr Manish Raj, Dr Pulkesh Singh, Dr Ankit Mittal, Dr Rakesh Vishwakarma

Abstract


Plantar fasciitis is an inflammation of the plantar fascia at the bottom of the foot. Though pathology of plantar fasciitis remains ill understood, there is evidence to suggest that it is probably initiated by repeated micro trauma.          Numerous methods have been advocated for treating plantar fasciitis, including rest, NSAID’s, night splints, foot orthosis, stretching protocols and ESWT (extra corporeal shock wave therapy) ,local laser application, autologous blood injection and local ultrasound application. Platelet rich plasma (PRP) is promoted as an ideal autologous biological blood-derived product, which can be exogenously applied to various tissues where it releases high concentrations of platelet derived growth factors that enhance wound healing, bone healing and also tendon healing. In current study evaluate the effectiveness of local infiltration of autologous platelet rich plasma (PRP) and compared the results with control group.

Method

                Present study conducted in department of orthopedics of a tertiary level 1000 bedded Super specialty Medical Collage situated in rural area of North India. Cases were selected from the patients attending routine OPD from January 2007 to December 2015 at orthopedics department. 10 ml of a patient's own blood was collected via blood draw, maintaining sterile technique, with SYRINGE and then mixed with 2 ml Acid citrate dextrose (anticoagulant). This was then put in Autologous Platelet Separator System (1500 RPM for 5 minutes), yielding platelet rich plasma (PRP) as supernatant. Under sterile conditions, patients were receiving a 3 cc PRP injection (consisting of their own PRP) into the origin of the plantar fascia and site of maximum tenderness. We followed up patients at 2 weeks, 4 weeks, 8 weeks, 12 weeks and final at 52 weeks. The results tabulated as per the Performa. We used visual analogue scale (VAS) for assessment of pain relief in two groups.

Results

                At the start of study the mean VAS of control group was 6.5 and mean VAS of case group (PRP) was 6.6. The mean VAS score in case group (PRP) decreases from baseline 6.6 at start to 0.54 at 52 wk during follow up. We noticed that there was maximum decrease in mean VAS score in case group from first week (VAS-6.6) to 12 weeks (VAS-1.7). We concluded that PRP injection at planter fasciitis site have much better outcome in relation to visual analogue score(VAS) and result difference was statistically significant. 

Conclusion

                Planter fasciitis is a very disabling disorder of foot leaving to very discomforting life and day to activity. Autologous platelet rich plasma (PRP) infiltration at the most tender part of heel is a effective method of management of these cases as compared to conservative management. This method also shown negligible complication rate and low recurrence rate. Conservative management of these cases had shown poor long term results.


Keywords


Platelet Rich Plasma, planter fasciitis, heel pain, local infiltration, autologous PRP

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