Abstract
Objective: The aim of this review is to compare the therapeutic effects of corticosteroids injections and platelet rich plasma therapy in the treatment for chronic plantar fasciitis that is refractory to conventional treatment options, using the Foot Function Index (FFI) score as an indicator of improvement
Design: Meta Analysis
Methods: A search of PubMed and CINAHL was performed in 2021 using the terms “‘plantar fasciitis’, and ‘prp or platelet rich plasma’ and ‘corticosteroids’ and ‘foot function index.’” Three articles were chosen to be included in qualitative synthesis.
Results: Studies from Peerbooms et al, Ugurlar et al, and Tabrizi et al were analyzed.
Conclusion: Corticosteroids are better than PRP in the short term, PRP is better up until 12 months. Neither treatment is efficacious after the 12 month period

Lepecha, Alexandra

Rankins, Grant

English

James Madison University

Plantar Fasciitis: Steroids or PRP?Alexandra Lepecha and Grant Rankins James Madison University, Harrisonburg ,VAOBJECTIVESMETHODSRESULTSCONCLUSIONSREFERENCESThe aim of this review is to compare the therapeutic effects of corticosteroids injections and platelet rich plasma therapy in the treatment for chronic plantar fasciitis that is refractory to conventional treatment options, using the Foot Function Index (FFI) score as an indicator of improvement. Reconstructed sieINTRODUCTION• Plantar fasciitis is the most common cause of heel pain in adults 1,2  • Pathophysiology: degradation of the fibrous tissue, fibroblastic proliferation, with or without evidence of chronic inflammation.2 • Etiologies: multifactorial; obesity, prolonged standing or jumping, flat feet, and reduced ankle dorsiflexion.2 • Prevalence: 10% of the populations 1,2 • Population: peak incidence- 40 and 60 years of age, another peak noted  in younger runners.2 • Therapies: ○ Conventional options:  stretching, weight loss, avoidance of flat shoes and barefoot walking, using foot inserts, decrease in intense physical activity, NSAIDs, corticosteroids, and local anesthetic.2 ○ Novel therapies: extracorporeal shock wave therapy, botulinum toxin injection, topical corticosteroids, radiotherapy, cryosurgery, low level laser therapy, electric microneedling, and autologous whole blood or platelet rich plasma therapy (PRP).2  Corticosteroids are advised for immediate relief of symptoms; however after the 3 month time frame, PRP injections have proven to be more effective in the general population. Both treatments are ineffective in symptom relief after the 12 month mark.  Application to the Patient: A dual therapy of corticosteroids and conservative treatments is recommended for the best treatment outcome. Corticosteroids were chosen over PRP injections for immediate relief and equal long term effects.  Best management: PRP and/or corticosteroids should be combined with other conservative therapies such as weight loss, heel lifts, NSAIDS, and activity management.  1. NIOSHTIC-2 Publications Search - 20041221 - The hazards of just standing around. Accessed October 8, 2021. https://www.cdc.gov/niosh/nioshtic-2/20041221.html2. Buchbinder R. Plantar Fasciitis. https://www.uptodate.com/contents/plantar-fasciitis?search=plantar%20fasciitis&source=search_result&selectedTitle=1~40&usage_type=default&display_rank=1#H83. Uğurlar M, Sönmez MM, Uğurlar ÖY, Adıyeke L, Yıldırım H, Eren OT. Effectiveness of Four Different Treatment Modalities in the Treatment of Chronic Plantar Fasciitis During a 36-Month Follow-Up Period: A Randomized Controlled Trial. J Foot Ankle Surg Off Publ Am Coll Foot Ankle Surg. 2018;57(5):913-918. doi:10.1053/j.jfas.2018.03.0174. Foot Function Index (FFI). Physiopedia. Accessed October 27, 2021. https://www.physio-pedia.com/Foot_Function_Index_(FFI)5. Peerbooms JC, Lodder P, den Oudsten BL, Doorgeest K, Schuller HM, Gosens T. Positive Effect of Platelet-Rich Plasma on Pain in Plantar Fasciitis: A Double-Blind Multicenter Randomized Controlled Trial. Am J Sports Med. 2019;47(13):3238-3246. doi:10.1177/03635465198771816. Tabrizi A, Dindarian S, Mohammadi S. The Effect of Corticosteroid Local Injection Versus Platelet-Rich Plasma for the Treatment of Plantar Fasciitis in Obese Patients: A Single-Blind, Randomized Clinical Trial. J Foot Ankle Surg. 2020;59(1):64-68. doi:10.1053/j.jfas.2019.07.004A.D is a 46 year old female presenting to the clinic for heel pain that she has experienced over the past year. Six months ago, she went to her primary care physician who recommended conservative therapy for her pain, this did not help. She is a nurse who is constantly on her feet and is frustrated with her pain. She's coming today to see if there are any “quick fix” options that can alleviate her pain and that can last for a long time. She stated that she has heard of corticosteroids as an established treatment, but has also heard of a new therapy- PRP- to treat plantar fasciitis. She is coming today because she wants to know which can help her more.DISCUSSIONCASE SCENARIOhttps://orthoinfo.aaos.org/en/diseases--conditions/plantar-fasciitis-and-bone-spursPatients: Ugurlar et al and Peerbooms et al has patients of various weight and had over 100 participants. Tabrizi et al had patients who were obsese and only had 32 participants. Another similarity was that Ugurlar et al and Peerbooms et al were double blinded studies whereas Tabrizi et al was only a single blind study. PRP and corticosteroids: Preparation and dosing of PRP was different in the Peerboms et al study as compared to the other two. Peerbooms et al injected 5-6mL whereas Taberzi injected 3 mL of PRP, Urgular did not specify the amount injected. Furthermore, each study used different corticosteroids for injection, Tabrizi et al used methylprednisolone, Ugurlar et al used betamethasone (1mL), and Peerbooms et al used triamcinolone acetonide (5-6mL). Other differences in administering PRP and corticosteroids included the use of ultrasound guidance for placement of injection into the fascia. Both Tebrezi et al and Peerbooms et al did not use ultrasound guidance whereas Ugular et al did. Post procedure protocol: Ugurlar et al told participants to apply ice and take acetaminophen tablets three times daily to relieve pain for three days. They did not advise of any activity or weight bearing limitations. Peerbooms et al had participants limit time on feet for the first 48 hours, and were instructed on doing stretching exercises for two weeks post procedure. NSAIDs were also prohibited in these participants, but could use hydrocodone and acetaminophen for pain. The participants could resume normal activities at 4 weeks post procedure. The study from Tabrizi et al stated that their limitation was the lack of post-protocol guidelines for their patients and patients were able to do typical activities after procedures. Follow up: Urgular et al followed up at 1, 3, 6, 12, 24, and 36 months post procedure. Peerbooms et al followed up at 1, 3, 6, and 12 months post procedure. Taberzi et al followed up at 1, 2, and 4 months, and 24 weeks.  The difference in the follow up did affect the results as PRP was seen to be effective in both Ugurlar et al and Peerbooms et al studies up until 12 months. Ugurlar et al was the only study that followed up after one year and showed that PRP was no longer effective after the one year mark. All studies mentioned that corticosteroids performed better than PRP in the first 3 months, but PRP was stated to be more effective after the 3 months in Ugurlar et and and Peerbooms et al studies. Tabrizi et al stated PRP was never more effective than corticosteroids, though they only followed up until 6 months. Positive Effect of Platelet Rich Plasma on Pain in Plantar Fasciitis 5Study design: Double blind multicenter prospective randomized control trial. 115 met inclusion criteria and were randomized to receive either platelet rich plasma (PRP) or control (corticosteroids) treatment via injection into the plantar fascia. Each patient was assessed on the Foot Function Index (FFI).  All outcomes were measured at baseline; 4, 12, and 26 weeks; and 1 year after the procedure.Study Results: At 0 and 3 months, the control group performed better than the PRP group for FFI Pain, Disability, and Activity. However at 6 and 12 months, PRP group performed better in all of these categories. Effectiveness of Four Different Treatment Modalities in the Treatment of Chronic Plantar Fasciitis During a 36-Month Follow-Up Period: A Randomized Controlled Trial 3Study design: This was a prospective, randomized control trial. 158 people who met inclusion criteria were randomly divided into the four treatment groups. The participants used the Visual Analog Scale (VAS) and the Foot Function Index (FFI) to score their improvement before treatment, at 1 month, 3 months, 6 months, 12 months, 24 months, and 36 months. Study Results: The VAS and FFI scores after 1 month of treatment for corticosteroids were significantly decreased, PRP did not show significant change. Both corticosteroid injections and PRP injections proved effective at reducing the VAS and FFI scores from 3 months to 12 months when compared to pretreatment levels, with PRP being slightly better. After the 12 month mark both treatment modalities were ineffective at showing any decrease in the VAS and FFI scores when compared to pretreatment levels. The Effect of Corticosteroid Local Injection Versus Platelet-Rich Plasma for the Treatment of Plantar Fasciitis in Obese Patients: A Single-Blind, Randomized Clinical Trial 6Study Design: A total of 32 people were considered eligible to participate in this single blind, randomized clinical trial, and were randomized into the two groups. The VAS and FFI scales were used to assess the results of the treatment, and they were filled out 2 months after the treatment was performed. Study Results: At 24 weeks post treatment significant decrease in pain was demonstrated in both treatment groups with regards to morning pain. The mean FFI of the patients treated with corticosteroid injection also showed significantly greater improvement in regard to pain, disability, and activity limitation compared with those injected with PRP.

Plantar fasciitis: Steroids or PRP?

https://commons.lib.jmu.edu/cgi/viewcontent.cgi?filename=0&article=1042&context=pacapstones202029&type=additional

Plantar Fasciitis: Steroids or PRP?

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