If you are suffering from chronic plantar fasciitis, platelet-rich plasma (PRP) injections may be the solution you have been looking for. PRP is a regenerative treatment that is more effective than corticosteroids for this condition. In this article, we will discuss the benefits of PRP injections for chronic plantar fasciitis.
What is platelet-rich plasma (PRP)?
Platelets are a component of blood and are primarily involved in blood clotting (hemostasis). Platelets contain a large number of proteins and cell-signaling molecules that can initiate tissue repair. Examples of some growth factors found in platelets include transforming growth factor beta (TGF-beta), platelet-derived growth factor (PDGF), fibroblast growth factor (FGF), and vascular endothelial growth factor (VEGF). The molecules are called cytokines and are important for various cellular processes like cell proliferation, cell migration, cell differentiation, and blood vessel formation.
Platelets are only one component of blood. The process of concentrating platelets includes drawing a sample of blood from the patient and then spinning the sample in a centrifuge to separate the blood into the different components allowing for isolation and concentration of the platelets.
PRP is created by taking platelets from the patient and then spinning them down to create a platelet-rich plasma (PRP) concentrate. This PRP can be injected back into the patient to help stimulate tissue healing. The concentration of platelets in PRP varies but is typically around three to five times higher than what is found in platelet-poor plasma (PPP).
How does platelet-rich plasma work to treat plantar fasciitis?
Connective tissues like the plantar fascia heal through three phases. This includes inflammation, proliferation, and remodeling. PRP injections are thought to work by initiating and enhancing the healing process in all three of these phases. The platelets in PRP release growth factors that stimulate cell proliferation, migration, and differentiation. This helps to initiate the healing process and leads to improved collagen production. In addition, PRP helps to promote blood vessel formation (angiogenesis) which can provide additional nutrients and oxygen to the tissue being repaired. All of this results in a more effective healing response for chronic plantar fasciosis.
What are the benefits of PRP injections for chronic plantar fasciitis sufferers?
Platelet-rich plasma injections for chronic plantar fasciitis can produce a more sustained outcome, relief, and increase in function. With chronic fasciitis, the plantar fascia, which is a very strong ligament that supports the arch, undergoes overuse, degeneration, thickening, and possible micro-tearing versus partial tearing. The tears can develop scar tissue which leads to even more thickening. If the process has been going on for a long time, the body essentially forgets that there is something to heal but it remains painful. PRP can be useful for these chronic cases because it can lead to tissue repair, and is a more sustained treatment option. Additionally, with chronic plantar fasciitis that has been unresponsive to the typical conservative treatment options, this could potentially be an option that would prevent someone from having to go to the OR for a more invasive procedure.
How effective is PRP treatment for chronic plantar fasciitis compared to other treatments options available on the market today?
Another common treatment modality used for plantar fasciitis is cortisone. Cortisone is a medication that gets injected into and around the fascia. Has many effects including being an anti-inflammatory. The interesting thing is, with chronic fasciitis, typically there is no inflammation appreciated. As such, how would something that intended to offer an anti-inflammatory effect beneficial to something that is not even inflamed!
With that being said, corticosteroid injection/cortisone is very helpful but at district foot and ankle we do not believe this is an effective option for chronic plantar fasciitis, especially if there is no inflammation, and absolutely if a patient has had multiple corticosteroid injections in the past. I do have multiple articles on the benefits and risks of cortisone injections with the most dreaded risk being a rupture of the plantar fascia.
At District Foot and Ankle, cortisone injections are typically reserved for patients that have new-onset symptoms of plantar fasciitis and are inflamed. This is best reserved for patients that are essentially limping into the office and need a quick fix. Cortisone injections used in isolation to treat plantar fasciitis will not be a permanent solution therefore other modalities need to be implemented simultaneously such as stretching, orthotics, and physical therapy.
It is also extremely important to have a thorough evaluation to ensure that heel pain is being caused by plantar fasciitis and not some other condition like sciatica, a bone tumor, or a stress fracture of the heel bone. I do have an article that outlines other reasons why heel pain might not be plantar fasciitis.
Who is a good candidate for PRP injections as a treatment option for chronic plantar fasciitis and who should avoid it altogether?’
Patients that have been suffering from heel pain for at least 3 to 6 months and are unsatisfied with the level of pain relief are good candidates for platelet-rich plasma injections. Typically, these patients have exhausted conservative treatment options including bracing, orthotics, anti-inflammatories, icing, physical therapy, night splints and other noninvasive/conservative modalities
What does a PRP injection involve?
PRP injections can be performed in both the office and operating room. The entire visit typically does not last more than 1 hour. The first step is to obtain a small sample of blood drawn from your arm. Your blood is prepared in a centrifuge which separates the blood into its various components. Next, the platelets are extracted and concentrated. This concentrated platelet solution, platelet-rich plasma, is then injected into the site of injury like the plantar fascia.
To ease discomfort during the procedure, a small amount of local anesthetic can be injected away from where the PRP is injected.
It is recommended that the foot be immobilized with a cam boot for approximately 2 weeks post-injection with an orthotic as well. At that time, activities can be advanced as tolerated. Typically during the first 4 to 6 weeks post-injection it is recommended to avoid anti-inflammatories like Motrin, Aleve, ibuprofen and to not ice the foot. Anti-inflammatories prevent normal inflammation which is desired with the injection and icing also acts as an anti-inflammatory.
Sometimes multiple injections are necessary for complete relief. If a positive but incomplete response is appreciated 6 weeks after the first injection, another injection could be considered.