Autologous platelet-rich plasma compared with whole blood for the treatment of chronic plantar fasciitis; a comparative clinical trial

Authors

1 Department of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Intralesional injection of autologous blood-derived products has recently gained attention as a potential treatment for plantar fasciitis (PF). We compared platelet-rich plasma (PRP) and whole blood (WB) for the treatment of chronic PF.
Materials and Methods: Patients with chronic PF received either an intralesional injection of 3 cc PRP prepared by double centrifuge technique or WB (n = 17 in each group). Overall, morning and walking pain severity were assessed by 11-point numerical rating scale, and function was assessed by the Roles and Maudsley score (RMS) at baseline and 1-month and 3 months after treatment. Ultrasonography was performed to measure plantar fascia thickness at baseline and 3 months after treatment.




Results: Pain scores were reduced over the study in the PRP (mean change = −5.00 ± 1.17 to −5.47 ± 1.46) and WB groups (mean change = −5.29 ± 2.56 to −6.47 ± 2.83), with no difference between groups (P > 0.05). One month and 3 months after treatment, successful treatment (RMS of ≤ 2) was respectively observed in 29.4% and 82.3% of the PRP and in 47.1% and 76.4% of the WB groups (P > 0.05). Also, fascia thickness was decreased in both the PRP and WB groups (mean change = −1.74 ± 1.11 vs. −1.21 ± 0.73 mm, respectively, P = 0.115).
Conclusions: Significant improvement in pain and function, as well as decrease in plantar fascia thickness, was observed by intralesional injection of the PRP and WB in patients with chronic PF. The study results indicate similar effectiveness between PRP and WB for the treatment of chronic PF in short-term.

Keywords

1.
Buchbinder R. Clinical practice. Plantar fasciitis. N Engl J Med 2004;350:2159-66.  Back to cited text no. 1
    
2.
Irving DB, Cook JL, Young MA, Menz HB. Impact of chronic plantar heel pain on health-related quality of life. J Am Podiatr Med Assoc 2008;98:283-9.  Back to cited text no. 2
    
3.
Tong KB, Furia J. Economic burden of plantar fasciitis treatment in the United States. Am J Orthop (Belle Mead NJ) 2010;39:227-31.  Back to cited text no. 3
    
4.
Thomas JL, Christensen JC, Kravitz SR, Mendicino RW, Schuberth JM, Vanore JV, et al. The diagnosis and treatment of heel pain: A clinical practice guideline-revision 2010. J Foot Ankle Surg 2010;49 3 Suppl:S1-19.  Back to cited text no. 4
    
5.
Hsiao MY, Hung CY, Chang KV, Chien KL, Tu YK, Wang TG. Comparative effectiveness of autologous blood-derived products, shock-wave therapy and corticosteroids for treatment of plantar fasciitis: A network meta-analysis. Rheumatology (Oxford) 2015; In Press: doi: 10.1093/rheumatology/kev010.  Back to cited text no. 5
    
6.
Tatli YZ, Kapasi S. The real risks of steroid injection for plantar fasciitis, with a review of conservative therapies. Curr Rev Musculoskelet Med 2009;2:3-9.  Back to cited text no. 6
    
7.
Tweed JL, Barnes MR, Allen MJ, Campbell JA. Biomechanical consequences of total plantar fasciotomy: A review of the literature. J Am Podiatr Med Assoc 2009;99:422-30.  Back to cited text no. 7
    
8.
Alsousou J, Ali A, Willett K, Harrison P. The role of platelet-rich plasma in tissue regeneration. Platelets 2013;24:173-82.  Back to cited text no. 8
    
9.
Laudy AB, Bakker EW, Rekers M, Moen MH. Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: A systematic review and meta-analysis. Br J Sports Med 2015;49:657-72.  Back to cited text no. 9
    
10.
Andia I, Maffulli N. Platelet-rich plasma for muscle injury and tendinopathy. Sports Med Arthrosc 2013;21:191-8.  Back to cited text no. 10
    
11.
Monto RR. Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis. Foot Ankle Int 2014;35:313-8.  Back to cited text no. 11
    
12.
Say F, Gürler D, Inkaya E, Bülbül M. Comparison of platelet-rich plasma and steroid injection in the treatment of plantar fasciitis. Acta Orthop Traumatol Turc 2014;48:667-72.  Back to cited text no. 12
    
13.
Creaney L, Wallace A, Curtis M, Connell D. Growth factor-based therapies provide additional benefit beyond physical therapy in resistant elbow tendinopathy: A prospective, single-blind, randomised trial of autologous blood injections versus platelet-rich plasma injections. Br J Sports Med 2011;45:966-71.  Back to cited text no. 13
    
14.
Raeissadat SA, Sedighipour L, Rayegani SM, Bahrami MH, Bayat M, Rahimi R. Effect of platelet-rich plasma (PRP) versus autologous whole blood on pain and function improvement in tennis elbow: A randomized clinical trial. Pain Res Treat 2014;2014:191525.  Back to cited text no. 14
    
15.
Raeissadat SA, Rayegani SM, Hassanabadi H, Rahimi R, Sedighipour L, Rostami K. Is Platelet-rich plasma superior to whole blood in the management of chronic tennis elbow: One year randomized clinical trial. BMC Sports Sci Med Rehabil 2014;6:12.  Back to cited text no. 15
    
16.
Zhao LL, Tong PJ, Xiao LW, Zhu QL, Xu B, Yan MH. Case-control study on local injection of autoallergic platelet rich plasma or whole blood for the treatment of tennis elbow. Zhongguo Gu Shang 2014;27:908-11.  Back to cited text no. 16
    
17.
Lee TG, Ahmad TS. Intralesional autologous blood injection compared to corticosteroid injection for treatment of chronic plantar fasciitis. A prospective, randomized, controlled trial. Foot Ankle Int 2007;28:984-90.  Back to cited text no. 17
    
18.
Kalaci A, Cakici H, Hapa O, Yanat AN, Dogramaci Y, Sevinç TT. Treatment of plantar fasciitis using four different local injection modalities: A randomized prospective clinical trial. J Am Podiatr Med Assoc 2009;99:108-13.  Back to cited text no. 18
    
19.
McPoil TG, Martin RL, Cornwall MW, Wukich DK, Irrgang JJ, Godges JJ. Heel pain – Plantar fasciitis: Clinical practice guildelines linked to the international classification of function, disability, and health from the orthopaedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther 2008;38:A1-18.  Back to cited text no. 19
    
20.
Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken) 2011;63 Suppl 11:S240-52.  Back to cited text no. 20
    
21.
Roles NC, Maudsley RH. Radial tunnel syndrome: Resistant tennis elbow as a nerve entrapment. J Bone Joint Surg Br 1972;54:499-508.  Back to cited text no. 21
    
22.
Haake M, Buch M, Schoellner C, Goebel F, Vogel M, Mueller I, et al. Extracorporeal shock wave therapy for plantar fasciitis: Randomised controlled multicentre trial. BMJ 2003;327:75.  Back to cited text no. 22
    
23.
Omara AS, Ibrahima ME, Ahmedb AS, Saida M. Local injection of autologous platelet rich plasma and corticosteroid in treatment of lateral epicondylitis and plantar fasciitis: Randomized clinical trial. Egypt Rheumatologist 2012;34:43-9.  Back to cited text no. 23
    
24.
Shetty VD, Dhillon M, Hegde C, Jagtap P, Shetty S. A study to compare the efficacy of corticosteroid therapy with platelet-rich plasma therapy in recalcitrant plantar fasciitis: A preliminary report. Foot Ankle Surg 2014;20:10-3.  Back to cited text no. 24
    
25.
Aksahin E, Dogruyol D, Yüksel HY, Hapa O, Dogan O, Celebi L, et al. The comparison of the effect of corticosteroids and platelet-rich plasma (PRP) for the treatment of plantar fasciitis. Arch Orthop Trauma Surg 2012;132:781-5.  Back to cited text no. 25
    
26.
Kim E, Lee JH. Autologous platelet-rich plasma versus dextrose prolotherapy for the treatment of chronic recalcitrant plantar fasciitis. PM R 2014;6:152-8.  Back to cited text no. 26
    
27.
Chew KT, Leong D, Lin CY, Lim KK, Tan B. Comparison of autologous conditioned plasma injection, extracorporeal shockwave therapy, and conventional treatment for plantar fasciitis: A randomized trial. PM R 2013;5:1035-43.  Back to cited text no. 27
    
28.
Mohseni-Bandpei MA, Nakhaee M, Mousavi ME, Shakourirad A, Safari MR, Vahab Kashani R. Application of ultrasound in the assessment of plantar fascia in patients with plantar fasciitis: A systematic review. Ultrasound Med Biol 2014;40:1737-54.  Back to cited text no. 28
    
29.
Ragab EM, Othman AM. Platelets rich plasma for treatment of chronic plantar fasciitis. Arch Orthop Trauma Surg 2012;132:1065-70.  Back to cited text no. 29
    
30.
Kampa RJ, Connell DA. Treatment of tendinopathy: Is there a role for autologous whole blood and platelet rich plasma injection? Int J Clin Pract 2010;64:1813-23.  Back to cited text no. 30
    
31.
Molloy T, Wang Y, Murrell G. The roles of growth factors in tendon and ligament healing. Sports Med 2003;33:381-94.  Back to cited text no. 31
    
32.
Zhang J, Wang JH. Platelet-rich plasma releasate promotes differentiation of tendon stem cells into active tenocytes. Am J Sports Med 2010;38:2477-86.  Back to cited text no. 32
    
33.
Baksh N, Hannon CP, Murawski CD, Smyth NA, Kennedy JG. Platelet-rich plasma in tendon models: A systematic review of basic science literature. Arthroscopy 2013;29:596-607.  Back to cited text no. 33
    
34.
Xu K, Al-Ani MK, Sun Y, Xu W, Pan L, Song Y, et al. Platelet-rich plasma activates tendon-derived stem cells to promote regeneration of Achilles tendon rupture in rats. J Tissue Eng Regen Med 2015; In Press: doi: 10.1002/term. 2020.  Back to cited text no. 34
    
35.
Kawasumi M, Kitoh H, Siwicka KA, Ishiguro N. The effect of the platelet concentration in platelet-rich plasma gel on the regeneration of bone. J Bone Joint Surg Br 2008;90:966-72.  Back to cited text no. 35
    
36.
Yamaguchi R, Terashima H, Yoneyama S, Tadano S, Ohkohchi N. Effects of platelet-rich plasma on intestinal anastomotic healing in rats: PRP concentration is a key factor. J Surg Res 2012;173:258-66.  Back to cited text no. 36
    
37.
Jo CH, Kim JE, Yoon KS, Shin S. Platelet-rich plasma stimulates cell proliferation and enhances matrix gene expression and synthesis in tenocytes from human rotator cuff tendons with degenerative tears. Am J Sports Med 2012;40:1035-45.  Back to cited text no. 37
    
38.
Xian LJ, Roy Chowdhury S, Bin Saim A, Bt Hj Idrus R. Concentration-dependent effect of platelet-rich plasma on keratinocyte and fibroblast wound healing. Cytotherapy 2015;17:293-300.  Back to cited text no. 38
    
39.
McMillan AM, Landorf KB, Gilheany MF, Bird AR, Morrow AD, Menz HB. Ultrasound guided corticosteroid injection for plantar fasciitis: Randomised controlled trial. BMJ 2012;344:e3260.  Back to cited text no. 39
    
40.
Schulhofer SD. Short-term benefits of ultrasound-guided corticosteroid injection in plantar fasciitis. Clin J Sport Med 2013;23:83-4.  Back to cited text no. 40
    
41.
Vahdatpour B, Sajadieh S, Bateni V, Karami M, Sajjadieh H. Extracorporeal shock wave therapy in patients with plantar fasciitis. A randomized, placebo-controlled trial with ultrasonographic and subjective outcome assessments. J Res Med Sci 2012;17:834-8.  Back to cited text no. 41
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