PRP TREATMENT

FOR PLANTAR
FASCIITIS
SPORTS SCIENCE AND PHYSICAL
ACTIVITY FACULTY

INDEX
1. INTRODUCTION:
a. What is Plantar Fasciitis?
b. What is PRP?
2. MAIN CONTENT: Different ideas from different experts and studies
a. How does it work
b. Its effect on chronical Plantar Fasciitis
c. Comparison between the use of PRP and Corticosteroids
d. Use in other diseases or injuries rather than Plantar Fasciitis
3. BIBLIOGRAPHY

INTRODUCTION
First of all, I have considered making a small introduction to explain
briefly what I am going to talk about. While choosing my topic on the
Ecuador Project, I ran into this new treatment called PRP; I read a bit
about it and found it interesting. Furthermore, I saw that it is being
used on a very common injury as it is Plantar Fasciitis and I instantly
decided to investigate about this treatment.

hat is Plantar Fasciitis?

Plantar fasciitis (also known as plantar fasciopathy or jogger's heel) is

a common painful disorder affecting the heel and underside of the
foot. It is a disorder of the insertion site of ligament on the bone and
is characterized by scarring, inflammation, or structural breakdown of
the foot's plantar fascia. It is often caused by overuse injury of the
plantar fascia, increases in exercise, weight or age.
Plantar fasciitis is the most common injury of the plantar fascia and is
the most common cause of heel pain. Approximately 10% of people
have plantar fasciitis at some point during their lifetime.
It is commonly associated with long periods of standing and is much
more prevalent in individuals with excessive inward rolling of the foot,
which is seen with flat feet. Among non-athletic populations, plantar
fasciitis is associated with obesity and lack of physical exercise.
The heel pain characteristic of plantar fasciitis is usually felt on the
bottom of the heel and is most intense with the first steps of the day.
Individuals with plantar fasciitis often have difficulty with dorsiflexion
of the foot, an action in which the foot is brought toward the shin. This
difficulty is usually due to tightness of the calf muscle or Achilles
tendon, the latter of which is connected to the back of the plantar
fascia. Most cases of plantar fasciitis resolve on their own with time
and respond well to conservative methods of treatment.

hat is PRP?

Platelet-rich plasma (Abbreviation: PRP) is blood plasma that has been

enriched with platelets. As a concentrated source of autologous
platelets, PRP contains (and releases through degranulation) several
different growth factors and other cytokines that stimulate healing of
bone and soft tissue.
The efficacy of certain growth factors in healing various injuries and
the concentrations of these growth factors found within PRP are the
theoretical basis for the use of PRP in tissue repair. The platelets
collected in PRP are activated by the addition of thrombin and calcium
chloride, which induces the release of these factors from alpha
granules.

MAIN CONTENT

ow does it work?

Platelet-rich plasma is autologous blood sample in which the

concentration of platelets is higher than physiological. Platelets have
in their granules a lot of growth factors that are locally released
when activated. They are molecules that can stimulate healing of a
damaged tissue, through processes of angiogenesis, myogenesis,
chemotaxis, cell recruitment and stimuli for cell proliferation or
differentiation and synthesis of extracellular matrix tissue.
The preparation involves the extraction of blood from the patient,
sample centrifugation and separation of the fraction with plasma and
platelet concentrate. Red cells are always separated. Leukocytes may
or may not be included, depending on the form of preparation. The
preparation of PRP can be applied as local injection, intra-articular
injection or as platelet rich fibrin gel, the latter being more solid and
more frequently used in surgical way.

ts effect on Chronical Plantar Fasciitis

Both articles 4 and 6 show us two different studies which purposes

were to document the clinical outcomes of patients who were treated
with PRP injections for plantar fasciitis to determine the degree of
effectiveness of PRP treatment for chronic plantar fasciitis. In both
studies, 25 patients were treated with PRP and were assessed for the

pain on Visual Analogue Scale (VAS) pre-injection and post-injection.

The average pre-injection pain in patients was 9.1 in Ragabs study
and 7 in OMalleys study (range 8-10). Post-Injection, the average
pain decreased to 1.6 in Ragabs study and to 4 in OMalleys.
Twenty-two patients (88 %) were completely satisfied, two patients (8
%) were satisfied with reservations, and one patient (4 %) was
unsatisfied with using the visual analog scale.
The conclusion reached in both studies was that Injection of PRP is
safe and doesnt affect the biomechanical function of the foot.
Furthermore, Ragab and Othmans successful early findings with
injection of PRP indicate that this may become a very commonly used
modality in treating this difficult condition.

omparison between the use of PRP and Corticosteroids

This comparison is a very interesting fact though in my research, Ive

found two studies that compare these treatments and have different
results but both of them reach the same conclusion: PRP is a safer
treatment.
In both studies (articles 2 & 3) between 40 and 60 patients divided in two
groups who were diagnosed as plantar fasciitis and treated conservatively
for at least 3 months and had no response to conservative treatment
modalities were involved in this study. The first group was treated by local
injection of corticoesteroids and the second group was treated by injecting
PRP.
The results obtained in Rocco Montos study were that the cortisone group
had a pretreatment average AOFAS score of 52, which initially improved to
81 at 3 months posttreatment but decreased to a final score of 56 at 24
months. In contrast, the PRP group started with an average pretreatment
AOFAS score of 37, which increased to 95 at 3 months, remained elevated
and had a final score of 92 at 24 months.
On the other hand, in Akahins study, there was no significant difference
between corticosteroid and PRP groups in visual analog scale scores. But the
conclusion reached was that when the potential complication of
corticosteroid treatment was taken into consideration, PRP injection seems
to be safer and at least having same effectivity in the treatment of plantar
fasciitis.

se in other diseases or injuries rather than Plantar

Fasciitis
Advances in the understanding of tissue repair mechanisms and the pivotal
role of growth factors have stimulated the use of platelet-rich therapies by
orthopedic surgeons and sports physicians, mainly with the aim of
stimulating and enhancing tissue healing. Thus far, platelet-rich
technologies have spawned additional ambitious endeavors, including
surgical and nonsurgical treatments in sports orthopedics. Reconstruction of
anterior cruciate ligament and tendon surgery and treatment of joint
injuries, tendinopathy or muscle tears are but a few examples of the
potential applications of this technology in the field of orthopedic sports
medicine. In Snchezs article, some of the most important therapeutic
applications using these approaches are presented, as are some of the
limitations, anti-doping concerns and future challenges in the field.

BIBLIOGRAPHY
1. Peerbooms, J., Laar, W., Faber, F., Schuller, H., Hoeven, H., & Gosens,
T. (n.d.). Use of platelet rich plasma to treat plantar fasciitis: Design of
a multi centre randomized controlled trial. BMC Musculoskeletal
Disorders, 69-69.
2. Rocco Mondo, R. (2014). Platelet-Rich Plasma Efficacy versus
Corticosteroid Injection Treatment for Chronic Severe Plantar
Fasciitis. American Orthopaedic Foot & Ankle Asosiation, 35(4), 313
318-313318.
3. Akahin, E., Doruyol, D., Yksel, H., Hapa, O., Doan, , elebi, L., &
Biimolu, A. (n.d.). The comparison of the effect of corticosteroids
and platelet-rich plasma (PRP) for the treatment of plantar
fasciitis. Archives of Orthopaedic and Trauma Surgery, 781-785.
4. Ragab, E., & Othman, A. (n.d.). Platelets rich plasma for treatment of
chronic plantar fasciitis. Archives of Orthopaedic and Trauma
Surgery, 1065-1070.
5. Snchez, M., Anitua, E., Orive, G., Mujika, I., & Andia, I. (n.d.). PlateletRich Therapies In The Treatment Of Orthopaedic Sport Injuries. Sports
Medicine, 345-354.
6. OMalley, M., Vosseller, J., & Gu, Y. (n.d.). Successful Use of PlateletRich Plasma for Chronic Plantar Fasciitis. HSS Journal , 129-133.