Abstract
- Raymond Rocco Monto, MD, Nantucket Cottage Hospital, 57 Prospect St, Ste 122, Nantucket, MA 02554, USA. Email: drmonto@hotmail.com
Background: Chronic
plantar fasciitis is a common orthopedic condition that can prove
difficult to successfully treat. In this study,
autologous platelet-rich plasma (PRP), a
concentrated bioactive blood component rich in cytokines and growth
factors, was
compared to traditional cortisone injection in
the treatment of chronic cases of plantar fasciitis resistant to
traditional
nonoperative management.
Methods: Forty
patients (23 females and 17 males) with unilateral chronic plantar
fasciitis that did not respond to a minimum of 4
months of standardized traditional nonoperative
treatment modalities were prospectively randomized and treated with
either
a single ultrasound guided injection of 3 cc PRP
or 40 mg DepoMedrol cortisone. American Orthopedic Foot and Ankle
Society
(AOFAS) hindfoot scoring was completed for all
patients immediately prior to PRP or cortisone injection (pretreatment =
time
0) and at 3, 6, 12, and 24 months following
injection treatment. Baseline pretreatment radiographs and MRI studies
were obtained
in all cases to confirm the diagnosis of plantar
fasciitis.
Results: The cortisone
group had a pretreatment average AOFAS score of 52, which initially
improved to 81 at 3 months posttreatment
but decreased to 74 at 6 months, then dropped to
near baseline levels of 58 at 12 months, and continued to decline 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 at 94 at 6
and 12 months, and had a final score of 92 at 24 months.
Conclusions: PRP was
more effective and durable than cortisone injection for the treatment of
chronic recalcitrant cases of plantar fasciitis.
Level of Evidence: Level I, prospective randomized comparative series.
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