Platelet rich plasma vs shock wave vs corticosteroids for plantar fasciitis

NewsBot · Dec 25, 2024

Role of corticosteroid (Methyl Prednisolone
Injection) Versus Platelet Rich Plasma (PRP) in
Treatment of Plantar Fasciitis
Dr. Govind Sharma et al
Source

Introduction: Plantar fasciitis (PF) is not an uncommon cause of heel pain whose treatment is not yet standardized.
Although platelet rich plasma (PRP) and corticosteroid (CS) injections are the two commonly used modalities, yet not much
importance has been given to the comparison of their roles in sustained functional improvement.
Aim: To study the effect of PRP and CS injections in PF and compare their effectiveness with respect to pain relief and
improvement of functional and patient satisfaction.
Material & methods: 50 cases were randomized into two groups: 25 patients (Group A) received a single injection of
autologous PRP and 25 in Group B received a single injection of CS (40 mg of methylprednisolone) by the random
selection. A structured home exercise program was demonstrated to both the groups, as baseline management. The
effectiveness was assessed and compared in pre-injection and post-injection at 3 and 6 months follow-up. Visual Analog
Scale (VAS), Roles and Maudsley (RM), and Foot Function Index (FFI) scoring systems were used as outcome measures.
Results: Mean ± SD of age was calculated to be, 42.31 ± 7.6 for Group A and 42.29 ± 8.0 for Group B. Most of the
participants in Group A [16 (64%)] & in Group B [15 (60%)] were females Mean VAS score at different follow up time
reveals, at 3rd month (Mean VAS 3.05 & 4.82 in group A & B respectively) and 6th month later (Mean VAS 1.67 & 4.12 in
group A & B respectively) follow up period, significant improvement was found in group A. There was a significant
improvement of FFI and RM score as well as at 6 months follow‑up (P = <0.001).
Conclusion: Injection of CS had an early effect, which is not sustainable, whereas PRP was found to have a prolonged
impact on pain relief and better pat
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NewsBot · Jan 3, 2025

Rock, paper, scissors: Resolving the conflicting results of randomized trials involving corticosteroid, platelet rich plasma (PRP) and placebo injections
John W. Orchard
JSAMS Plus Volume 5, June 2025, 100081

Objective
To explore whether there is evidence of a rock-paper-scissors phenomenon in injections for various musculoskeletal conditions whereby platelet rich plasma (PRP) injections outperform corticosteroid injections (CSI) in randomized trials, corticosteroid outperforms placebo whereas PRP does not outperform placebo.
Methods
Narrative review searching for examples of musculoskeletal conditions which have high level evidence of this proposed rock-paper-scissors phenomenon.
Results
High quality studies or reviews could be found for lateral epicondylitis (tennis elbow), knee osteoarthritis, rotator cuff tendinopathy and plantar fasciitis suggestive of a rock-paper-scissors phenomenon. This was consistently in the direction of PRP injections having superior results to corticosteroid injections, corticosteroid injections having superior results to placebo, but then evidence that PRP injections were not superior to placebo. The most consistent result of the triumvirate was that PRP injections consistently outperformed corticosteroid injections in the medium-term (4 to 12 months).
Discussion
There appears to be somewhat of a rock-paper-scissors phenomenon for four common musculoskeletal conditions, with the significant limitation that this was a finding of a narrative review, limited by a non-systematic search protocol. The underlying explanation is that PRP is superior to corticosteroid in the medium-term (but not the short-term), corticosteroid is superior to placebo in the short-term (only) with PRP not being superior to placebo in either short- or medium-term in well-blinded trials. The most likely explanation for this phenomenon is that corticosteroid injections are helpful for musculoskeletal conditions in the short term (≤8 weeks) but are actually harmful in the medium-term (3 months and beyond). Systematic reviews which further explore this phenomenon are justified to help provide practical evidence-based advice on when to, if ever, use PRP and corticosteroid injections for musculoskeletal conditions.
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NewsBot · Jan 7, 2025

PRP Injections for the Treatment of Knee Osteoarthritis: The Improvement Is Clinically Significant and Influenced by Platelet Concentration: A Meta-analysis of Randomized Controlled Trials
Alessandro Bensa, MD, et al
Source

Background:
Platelet-rich plasma (PRP) has emerged as a promising therapeutic intervention for knee osteoarthritis (OA), attracting substantial clinical and research attention. However, the clinical relevance of the treatment benefit remains controversial.
Purpose:
To evaluate the effectiveness of PRP compared with placebo in patients with knee OA in terms of minimal clinically important difference (MCID) and to investigate the possible influence of platelet concentration on the clinical outcome.
Study Design:
Meta-analysis. Level of evidence 1.
Methods:
The search was conducted on 5 databases (PubMed, Cochrane Library, Scopus, Embase, Web of Science) using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were randomized controlled trials comparing PRP and placebo injections to treat knee OA, written in the English language, with no time limitation. The effects were quantified at 1-, 3-, 6-, and 12-month follow-up points. Visual analog scale (VAS) for pain and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were used, with subanalyses based on platelet concentration performed using a 1,000,000 ± 20% platelets/µL cutoff. The MCID values (VAS, 1.37; WOMAC, 6.4) were used to interpret clinical improvement. The articles’ quality was assessed using the Revised Tool for Risk of Bias in Randomized Trials and the Grading of Recommendations Assessment, Development and Evaluation guidelines.
Results:
Among the 5499 articles retrieved, 18 randomized controlled trials (1995 patients) were included. PRP presented statistically superior improvements in VAS and WOMAC scores compared with placebo at all follow-up points, exceeding the MCID at 3- and 6-month follow-up points for VAS and at all follow-up points for WOMAC. The subanalysis based on platelet concentration showed that high-platelet PRP provided clinically significant pain relief with the improvement exceeding the MCID compared with placebo at 3-, 6-, and 12-month follow-up points. In contrast, low-platelet PRP failed to offer a clinically perceivable benefit in terms of VAS score. WOMAC results showed that both products provided a clinically significant improvement at 3 and 6 months of follow-up. This benefit was maintained up to the 12-month follow-up in the high-platelet group but not in the low-platelet group, where the improvement compared with placebo did not reach statistical significance.
Conclusion:
This meta-analysis showed that PRP offered clinically relevant functional improvement at 1-, 3-, 6-, and 12-month follow-up points and pain relief at 3- and 6-month follow-up points compared with placebo for the treatment of knee OA. Platelet concentration was found to influence treatment efficacy, with high-platelet PRP providing superior pain relief and more durable functional improvement compared with low-platelet PRP.
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NewsBot · Feb 18, 2025

Ultrasonography-Guided Dextrose Prolotherapy Versus Platelet-Rich Plasma Injections for the Treatment of Plantar Fasciitis: A Randomized Controlled Trial
Neelam Kumari et al
Cureus. 2025 Jan 16;17(1):e77566.

Introduction: Heel pain is prevalent in foot and ankle practice, with plantar fasciitis being a common cause of chronic heel pain in adults. It is a degenerative condition of the plantar fascia, rendering the term fasciitis inaccurate. The condition has several alternative names, including painful heel syndrome and heel spur syndrome. It is found that a significant number of people suffer from plantar fasciitis at some stage of their lives; athletes and women between 40 and 60 years and adults aged more than 65 suffer the most. Patients typically report tenderness at the medial aspect of the heel, and pain is mostly under the surface of the heel, especially with initial morning steps. Plantar fasciitis is predominantly unilateral. Treatment options include prolotherapy and platelet-rich plasma (PRP), with this randomized controlled trial (RCT) aiming to evaluate the efficacy of PRP versus 25% dextrose prolotherapy in alleviating plantar fasciitis symptoms.

Aims and objectives: This study aimed to assess the comparative effectiveness of USG-guided 25% dextrose prolotherapy and autologous PRP injections on pain intensity, foot function, and ankle outcomes in plantar fasciitis cases.

Methodology: The study took place at the Department of Physical Medicine and Rehabilitation (PMR), King George's Medical University (KGMU), Lucknow, Uttar Pradesh, India, with eligible patients evaluated. Group A received 25% dextrose prolotherapy, while Group B was administered autologous platelet-rich plasma. Outcome measures, including pain by Pain Intensity Scale (PIS) and assessment of disability by Foot Function Index (FFI) and Foot and Ankle Outcome Score (FAOS), were assessed at baseline and the third and sixth weeks after intervention.

Results: A total of 44 patients were randomized into two groups of 22. Group A received dextrose prolotherapy, while Group B was treated with PRP injections as per the study protocol. The average age of participants in our study was 36.10±10.0 years. Female participants were more affected than male participants in both groups. Overall, the male-female ratio was 38.6:61.4, while in Group A and Group B, this ratio was 45.5:54.5 and 31.8:68.2, respectively. The presentation of plantar fasciitis was bilateral (40.9%), on the right side (40.9%), and on the left side (18.2%). The right side was more frequently involved than the left side of the plantar fascia. There was a decrease in the average PIS score of Groups A and B at the baseline, which was 7.27±1.24 and 7.55±1.26, respectively, which was reduced to 3.18±1.30 and 2.50±0.67 after six weeks of follow-up. The average FFI score of Groups A and B at the baseline was 98.64±17.68 and 95.36±19.01, respectively, which was reduced to 79.77±12.77 and 63.77±18.50 after six weeks of follow-up. The average FAOS score of Groups A and B at the baseline was 71.36±13.95 and 74.86±28.72, respectively, which was reduced to 74.86±28.72 and 42.09±5.03 after six weeks of follow-up.

Conclusion: Both 25% dextrose prolotherapy and PRP injections are effective treatments for plantar fasciitis. Both are minimally invasive and safe treatments for plantar fasciitis.
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NewsBot · Mar 6, 2025

Platelet-Rich Plasma Versus Corticosteroids in the Treatment of Plantar Fasciitis: A Systematic Review and Meta-Analysis
Zuo, Ankai et al
American Journal of Physical Medicine & Rehabilitation ():10.1097/PHM.0000000000002677, January 8, 2025. | DOI: 10.1097/PHM.0000000000002677

Objective
This study aims to compare the efficacy of platelet-rich plasma (PRP) and corticosteroids (CS) in treating plantar fasciitis, focusing on pain relief, foot function, and plantar fascia thickness to identify the optimal treatment approach.

Design
A comprehensive search of medical databases was conducted following PRISMA guidelines, utilizing an extensive keyword strategy. Inclusion criteria encompassed prospective RCTs involving adult patients with plantar fasciitis treated with local PRP or CS injections, specifically assessing outcomes such as the Visual Analogue Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) scores, and plantar fascia thickness.

Results
The meta-analysis included 24 RCTs with 1653 participants. PRP injections yielded significantly better VAS scores compared to CS injections at 3 months (P = 0.03) and 6 months (P < 0.001), with no significant differences at 1 month (P = 0.12) and 12 months (P = 0.08). AOFAS scores demonstrated that PRP was superior to CS at 3 (P = 0.05), 6 (P < 0.001), and 12 months (P < 0.001), with no significant differences at 1 month (P = 0.31). Regarding plantar fascia thickness, there were no significant differences between PRP and CS at 1-1.5 months (P = 0.18), 3 months (P = 0.64), and 6 months (P = 0.05).

Conclusions
PRP injections offer superior pain control compared to corticosteroids in the medium term (3-6 months) but not in the short term or at one year.
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Platelet rich plasma vs shock wave vs corticosteroids for plantar fasciitis

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Platelet rich plasma vs shock wave vs corticosteroids for plantar fasciitis

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Platelet-rich plasma for plantar warts

Platelet rich plasma for sesamoid injuries

Platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis

Intraoperative use of Platelet-Rich Plasma

Platelet-rich plasma in treatment of chronic venous leg ulcers

Platelet rich plasma for plantar plate injuries

Platelet rich plasma for fractures

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