Syed Saad Kadri¹, S Anjaiah^2*

^1,2Consultant, Department of Orthopaedic, Sai Sanjeevni Hospital, Kothapeth Hyderabad, Telangana, INDIA.

Email: dr.syedsaad@gmail.com

RESULTS

 In present study, 100 patients were randomly divided into group PRP (n=50) and group steroid (n=50). Majority were from 41-50 years age group and were female. Age and sex were comparable among both groups and difference was not significant statistically.

Table 1: Age and sex distribution

               VAS score was calculated at baseline, at 1,3 and 6 months among both groups. Baseline VAS scores were comparable and difference was not significant statistically. VAS scores were better in PRP group at 1,3 and 6 months as compared to steroid group and difference was significant statistically (p<0.05).

Table 2: VAS score

Mean AOFAS score were comparable at baseline, at 1 months among both groups and difference was not significant statistically (p>0.05). Mean AOFAS score were better in PRP group at 3 and 6 months as compared to steroid group and difference was significant statistically (p<0.05).

Table 3: Mean AOFAS score

DISCUSSION

Several terminologies were used to describe pain at the plantar surface of the heel, which includes policeman’s heel, heel spur syndrome, joggers heel, sub‑calcaneal pain, plantar heel pain, plantar fasciopathy, plantar fasciitis (PF), and plantar fasciosis.⁶ In chronic cases, due to cumulative trauma, the micro‑tears at its attachment cannot heal, leading to collagen denaturation. A degenerative mechanism in PF is established with histological findings such as collagen necrosis, chondroid metaplasia, and calcification.⁷ Medical managements such as nonsteroidal anti‑inflammatory drugs (NSAID), local corticosteroid (CS) injection, platelet‑rich plasma (PRP) injection, and prolotherapy are used for the treatment of PF.⁸ Hypovascularity of plantar fascia prevents accessibility to a high concentration of platelet and other growth factors for natural repair. Injection of PRP directly delivers platelets into the lesion, which releases, platelet‑derived growth factor, transforming growth factor beta, endothelial growth factors, that accelerate tissue healing.^9,10 In study by Upadhyay S et al.,¹¹ among140 heels with follow up duration of 6 months. The score on VAS scale and AOFAS improved from base line for both group but the patients received PRP therapy had a statistically significant (p<0.05) reduction in pain and improved AOFAS score at last follow up. The result of present study showed that the PRP therapy has potential to reduce pain and improve the functional outcome in cases of chronic planter fasciitis. It was found to be more effective and significantly better than corticosteroid injection. Similar findings were noted in present study. In a similar study, Sahoo PK et al.,¹² noted that corticosteroids (CSs) had an early effect, reducing pain to a moderate level in 82.4% of patients compared to PRP (P = 0.000). However, the effect was not sustainable over a long period. On the other hand, PRP was found to have better pain relief over 3 months and 6 months follow‑up with a mean VAS score of 2.0 ± 0.9 and 0.8 ± 0.8, respectively. There was a significant improvement of FFI and RM score as well as at 6 months follow‑up (P = 0.000). Therefore, PRP can be advised for sustained and prolonged improvement in PF. Similar findings were noted in present study. In study by Tank G et al.,¹³ platelet-rich plasma and corticosteroid injection groups at the initial visit had VAS score of 8.44 and 8.38 respectively which was reduced to 1.46 and 3.02 at the end of 6 months. The PRP and corticosteroid injection groups at the initial visit had FAAM score of 29.9 and 31.6 respectively which increased to 83.4 and 69.1 at the end of 6 months. After injection, the PRP group had significant reduction (35.90%) in the thickness of plantar fascia as compared to corticosteroid group (28.67%). Treatment of PF with PRP extract reduces pain and significantly increases function, exceeding the effect of steroid on long-term follow-up. Multiple steroid injections are required for effective and long-term pain relief but they can cause rupture of fascia and atrophy of the fat pad.¹⁴ Fascial rupture interferes with the foot windlass mechanism and promotes inflammation in the neighboring tissue. Atrophy of the plantar fat pad reduces the subcalcaneal cushioning, making it more susceptible to trauma and pain.¹⁵ Conventionally, depot steroid injections delivered close to plantar fascia insertion at the calcaneum are considered as an effective early intervention. A recent Cochrane review however concluded that local steroid injections, in comparison to placebo or no treatment, may slightly reduce heel pain but only up to 1 month and not subsequently. Tendon rupture, collagen necrosis, plantar fascia rupture, plantar fat pad atrophy, plantar nerve injury, calcaneal osteomyelitis, and skin necrosis are some of the reported side effects of local steroid injections.^16,17 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 addition PRP possesses antimicrobial properties that may contribute to the prevention of infections.^18,19

CONCLUSION

For the treatment of PF, platelet rich plasma (PRP) is more effective as compared to corticosteroid injection at achieving symptom relief at 3 and 6 months after first injection. The short-term results of PRP injections shows clinical and statistically significant improvements in VAS for heel pain, functional outcome scores. Thus, PRP injection is better for long-term pain relief in planter fasciitis.

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