Comparison between Platelet Rich Plasma and Corticosteroid Injection in Treatment of Plantar Fasciitis: A Systematic Review

Background: Plantar fasciitis (PF) is considered as degenerative tendinopathies. Repeated micro trauma is the major etiology of these diseases. Autologous platelet rich plasma (PRP) injections are becoming more popular in the treatment of enthesopathies like PF. The growth factors in PRP cause tissue healing. We compared the result of injecting intra-lesional autologous PRP injections versus steroid infiltration in chronic PF.Methods: A prospective, interventional and analytic comparative study was done and 81 patients (120 heels) were included in this study and were followed up for 6 months. We assessed the outcome of each patient using visual analog score (VAS) and foot and ankle disability index (FADI) on follow-up at 1, 3, and 6 months. Results: In our study, female preponderance was seen. Left side was more common as compared to right side. Unilateral PF is more common than bilateral. The difference with in the individual group at baseline and at 1,3 and 6 months was statistically highly significant in terms of VAS and FADI (p=0.0001) But the difference in the between the two groups was insignificant for VAS and FADI at 1, 3 and 6 months.Conclusions: In our study, as there is no significant difference in VAS and FADI score between corticosteroid injection group and PRP injection group at 1, 3 and 6 months follow up. So, it’s reasonable to conclude that both are equally effective in PF. But as PRP injection comes out to be more time consuming and more costly, corticosteroid seems to be more efficient, cost and time wise. Hence, the latter should be a better choice.

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Platelet-Rich Plasma Versus Corticosteroid Injections in the Management of Elbow Epicondylitis and Plantar Fasciitis: An Updated Systematic Review and Meta-analysis

The American Journal of Sports Medicine ◽

10.1177/0363546519888450 ◽

2019 ◽

Vol 48 (10) ◽

pp. 2572-2585 ◽

Cited By ~ 2

Author(s):

Kai Huang ◽

Grey Giddins ◽

Li-dong Wu

Keyword(s):

Systematic Review ◽

Clinical Efficacy ◽

Effect Size ◽

Plantar Fasciitis ◽

Platelet Rich Plasma ◽

Meta Analysis ◽

Medium Effect ◽

Large Effect Size ◽

Short Term

Background: Platelet-rich plasma (PRP), as a promising alternative to traditional corticosteroid (CS), is now increasingly used in the treatment of elbow epicondylitis (EE) and plantar fasciitis (PF). To date, however, the synthesis of information on the clinical efficacy of PRP versus CS is limited with divergent conclusions. Purpose: To compare the clinical efficacy of PRP and CS injections in reducing pain and improving function in EE and PF. Study Design: Systematic review and meta-analysis. Methods: Online databases were searched from inception to October 2018 for prospective studies evaluating PRP versus CS injections for EE or PF. Independent reviewers undertook searches, screening, and risk-of-bias appraisals. The primary outcomes of interest were pain and function in both the short term (1-3 months) and the long term (≥6 months). Results: Twenty trials with 1268 participants were included. For EE, PRP provides a statistically and clinically meaningful long-term improvement in pain, with a very large effect size of −1.3 (95% CI, −1.9 to −0.7) when compared with CS, but the evidence level was low. For EE, there was moderate evidence that CS provides a statistically meaningful improvement in pain in the short term, with a medium effect size of 0.56 (95% CI, 0.08-1.03) as compared with PRP; this improvement might not be clinically significant. For PF, there was low evidence that PRP provides a statistically and clinically meaningful long-term improvement in function (American Orthopedic Foot & Ankle Society score), with a very large effect size of 1.94 (95% CI, 0.61-3.28). There were no significant differences between the groups in improvement in function in EE and pain and short-term function in PF, but the quality of the evidence was low. Conclusion: The use of PRP yields statistically and clinically better improvement in long-term pain than does CS in the treatment of EE. The use of PRP yields statistically and clinically better long-term functional improvement than that of CS in the treatment of PF.

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Is platelet rich plasma superior to corticosteroid injection for recalcitrant plantar fasciitis? Results of a prospective comparative study

IP International Journal of Orthopaedic Rheumatology ◽

10.18231/j.ijor.2020.014 ◽

2021 ◽

Vol 6 (2) ◽

pp. 58-61

Author(s):

Jambukeswaran PST ◽

Arun Kumar Somasundaram ◽

Sathish Muthu

Keyword(s):

Comparative Study ◽

Plantar Fasciitis ◽

Platelet Rich Plasma ◽

Corticosteroid Injection ◽

Prospective Comparative Study

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A comparative study of effectiveness of local injection of autologous platelet rich plasma and injection corticosteroid solution in treatment of plantar fasciitis

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20190801 ◽

2019 ◽

Vol 5 (2) ◽

pp. 335

Author(s):

Vithal Prakash Puri ◽

Anil Kumar Gaur

Keyword(s):

Plantar Fasciitis ◽

Platelet Rich Plasma ◽

Corticosteroid Injection ◽

Care Center ◽

Tertiary Care ◽

Vas Score ◽

Visual Analog Scales ◽

Group A ◽

Group B

Background: The heel pain is the most common problem worldwide and it was associated with plantar fasciitis (PF). The condition of treatment is very complex. Platelet-rich plasma (PRP) and injection of corticosteroids is the treatment of PF. This study was designed to access the effect of local PRP and local corticosteroid injection in PF patients.Methods: Sixty patients (between 29 to 60 years of age) with chronic PF were randomized prospectively in single tertiary care center in India. The study conducted from December 2013 to December 2015. All the patients were enrolled according to inclusion criteria and divided into two groups randomized. In group A (n=30) received PRP and group B (n=30) received corticosteroids injections. Visual analog scales (VAS) were filled by all the included patients. The follow-up scheduled at one and six months after complete enrolment of patients.Results: Between both the groups the significantly different observed at one and six months follow-up from the baseline. At one month follow-up significantly improvement in mean VAS score were observed in group B (p<0.001). At six months follow-up significantly improvement in mean VAS score were observed in group A (p<0.001).Conclusions: The present study concluded from the significance difference between both the groups proved promising form of treatment in chronic PF patients. Both the treatment was safe and effective in relieving pain improving function at different time period.

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TL 18176 - Platelet-rich plasma versus corticosteroid injection in pain and disability outcomes in patients with plantar fasciitis

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2019.v13.1081 ◽

2019 ◽

Vol 13 (Supl 1) ◽

pp. 102S

Author(s):

Janice De Souza Guimarães ◽

Fabio Luciano Arcanjo de Jesus ◽

Gustavo Leporace De Oliveira Lomelino So ◽

Leonardo Fossati Metsavaht ◽

Marcus Vinicius Mota Garcia Moreno ◽

...

Keyword(s):

Plantar Fasciitis ◽

Platelet Rich Plasma ◽

Corticosteroid Injection

Introduction: Fascite Plantar é a causa mais comum de dor no calcanhar e muitas vezes responde a uma ampla gama de terapias. Atualmente existem muitas opções de tratamento, sendo que algumas, como plasma rico em plaquetas e injeção de corticosteroides, apresentam grande sucesso no alívio da dor. Entretanto, não há consenso sobre o melhor método de tratamento. O objetivo desta revisão sistemática e meta-análise foi investigar os efeitos do plasma rico em plaquetas versus injeção de corticosteróides em desfechos de dor e incapacidade no paciente com fascite plantar. Métodos: Os estudos foram amplamente pesquisados em PubmedMEDLINE, na base de dados PEDro, na biblioteca eletrônica científica online (SciELO) e no registro central de ensaios controlados da Cochrane, desde a data mais antiga disponível até janeiro de 2019. Foram incluídos ensaios clínicos controlados randomizados que compararam os efeitos do plasma rico em plaquetas versus injeção de corticosteróides para paciente com fascite plantar. Foram calculados as diferenças médias (DM) e intervalos de confiança (ICs) de 95%, e a heterogeneidade foi avaliada usando o teste I2. Os cálculos foram feitos usando um modelo de efeito aleatório. Resultados: Dez artigos preencheram os critérios do estudo, incluindo 475 pacientes com fascite plantar. Os principais resultados incluíram alterações da linha de base no Escore da Escala Visual Analógica (dor) e no Escore da Sociedade Ortopédica Americana do Pé e Tornozelo (incapacidade). A terapia com plasma rico em plaquetas resultou em melhora na dor (DM -1,01 IC95%: -1,8 a -0,3, N=375) em comparação com a injeção de corticosteróides. Não foi encontrada nenhuma diferença significativa na incapacidade (DM 6,5 IC95%: -15,8 a 29,0, N=156) em participantes do grupo de terapia com plasma rico em plaquetas em comparação com o grupo de injeção de corticosteróides. Além disso, nenhum evento adverso grave foi relatado. Conclusão: O plasma rico em plaquetas foi mais eficaz do que a injeção de corticosteróides e tem o potencial de reduzir a dor do paciente com fascite plantar.

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The effect of corticosteroid versus platelet-rich plasma injection therapies for the management of lateral epicondylitis: A systematic review

SICOT-J ◽

10.1051/sicotj/2017062 ◽

2018 ◽

Vol 4 ◽

pp. 11 ◽

Cited By ~ 17

Author(s):

Walid Ben-Nafa ◽

Wendy Munro

Keyword(s):

Systematic Review ◽

Platelet Rich Plasma ◽

Corticosteroid Injection ◽

Lateral Epicondylitis ◽

Extensor Tendon ◽

Symptomatic Improvement ◽

Tendon Thickness ◽

Randomised Controlled ◽

Level 2 ◽

Corticosteroid Injections

Introduction: Lateral epicondylitis is a common musculoskeletal disorder of the upper limb. Corticosteroid injection has been widely used as a major mode of treatment. However, better understanding of the pathophysiology of the disease led to a major change in treating the disease, with new options including platelet-rich plasma (PRP) are currently used. Objectives/research aim: To systematically evaluate the effect of corticosteroid versus PRP injections for the treatment of LE. Hypothesis: PRP injections provide longer-term therapeutic effect and less rate of complications compared to corticosteroid injection. Level of evidence: Level 2 evidence (4 included studies are of level 1 evidence, 1 study of level 2 evidence). Design: Systematic Review (according to PRISMA guidelines). Methods: Eleven databases used to search for relevant primary studies comparing the effects of corticosteroid and PRP injections for the treatment of LE. Quality appraisal of studies performed using Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0, CASP Randomised Controlled Trial Checklist, and SIGN Methodology Checklist 2. Results: 732 papers were identified. Five randomised controlled trials (250 Patients) met the inclusion criteria. Clinical findings: Corticosteroid injections provided rapid symptomatic improvement with maximum effect at 6/8/8 weeks before symptoms recurrence, whereas PRP showed slower ongoing improvements up to 24/52/104 weeks(3 studies). Corticosteroid showed more rapid symptomatic improvement of symptoms compared to PRP up to the study end-point of 3 months(1 study). Comparable therapeutic effects of corticosteroid and PRP were observed at 6 weeks(1 study). Ultrasonographic Findings: (1) Doppler activity decreased more significantly in patients who received corticosteroid compared to PRP. (2) Reduced tendon thickness and more patients with cortical erosion noted in corticosteroid group whereas increased tendon thickness and less number of patients with common extensor tendon tears noted in PRP group. (3) Fewer patients reported Probe-induced tenderness and oedema in the common extensor tendon in both corticosteroid and PRP groups (2 studies). Conclusion: Corticosteroid injections provide rapid therapeutic effect in the short-term with recurrence of symptoms afterwards, compared to the relatively slower but longer-term effect of platelet-rich plasma.

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Effectiveness of Corticosteroid Injections in the Treatment of Plantar Fasciitis

Journal of Sport Rehabilitation ◽

10.1123/jsr.2014-0234 ◽

2016 ◽

Vol 25 (2) ◽

pp. 202-207 ◽

Cited By ~ 4

Author(s):

Shanna L. Karls ◽

Kelli R. Snyder ◽

Peter J. Neibert

Keyword(s):

Plantar Fasciitis ◽

Platelet Rich Plasma ◽

Corticosteroid Injection ◽

Term Treatment ◽

Clinical Scenario ◽

Bottom Line ◽

Long Term Treatment ◽

Level 2 ◽

Corticosteroid Injections

Clinical Scenario:For active individuals, plantar fasciitis (PF) is one of the most clinically diagnosed causes of heel pain. When conservative treatment fails, one of the next most commonly used treatments includes corticosteroid injections. Although PF has been identified as a degenerative condition, rather than inflammatory, corticosteroid injection is still commonly prescribed. However, the literature has not been examined to determine the effect of corticosteroid injection on PF.Focused Clinical Question:Are corticosteroid injections more effective than other interventions (placebo, platelet-rich plasma, and tenoxicam injections) in the short- and long-term treatment of PF?Summary of Key Findings:Corticosteroid injections are not more effective in the long-term treatment of PF pain than other treatments (platelet-rich plasma, tenoxicam).Clinical Bottom Line:The level 2 and 3 evidence shows that corticosteroids are more effective than placebo injections but are no more effective than tenoxicam injections and perhaps less effective than platelet-rich plasma treatment.Strength of Recommendation:Level 2 and 3 evidence suggests that corticosteroid injections are not more effective in the long-term treatment of PF than platelet-rich plasma or tenoxicam.

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