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VOLUME 11 , ISSUE 4 ( October-December, 2024 ) > List of Articles

REVIEW ARTICLE

Healing Heels: A Meta-analysis of Platelet-rich Plasma vs Corticosteroid Injections in Plantar Fasciitis Treatment

Clevio Desouza, Vijay Shetty

Keywords : Corticosteroid injections, Heel pain, Meta-analysis, Plantar fasciitis, Platelet-rich plasma, PRP, Systematic review

Citation Information : Desouza C, Shetty V. Healing Heels: A Meta-analysis of Platelet-rich Plasma vs Corticosteroid Injections in Plantar Fasciitis Treatment. J Foot Ankle Surg Asia-Pacific 2024; 11 (4):169-176.

DOI: 10.5005/jp-journals-10040-1368

License: CC BY-NC 4.0

Published Online: 20-09-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Introduction: Plantar fasciitis (PF) is a common cause of heel pain, particularly affecting individuals involved in running sports and those with prolonged standing activities. While various nonoperative treatments are available, there is no consensus on the optimal therapy. Corticosteroid injections offer short-term relief but have associated risks and limited long-term efficacy. Platelet-rich plasma (PRP) has emerged as a potential alternative, with conflicting evidence regarding its effectiveness compared to corticosteroids. Materials and methods: This systematic review and meta-analysis adhered to Cochrane and PRISMA guidelines. We included level 1 and level 2 studies from 2015 to 2023 that compared intralesional corticosteroid and PRP injections for treating PF with at least 6 months of follow-up. Comprehensive searches were conducted in Medline, Embase, Scopus, and Google Scholar. Data extraction and quality assessment were independently performed by two reviewers, using the Cochrane risk of bias tool. Statistical analyses, including heterogeneity and subgroup analyses, were conducted using Review Manager 5.3. Results: From 826 initial studies, 13 met inclusion criteria, encompassing 941 patients (PRP 476, corticosteroids 465). Platelet-rich plasma demonstrated no significant pain relief over corticosteroids at 3 months [standard mean difference (SMD) = −0.37; 95% confidence interval (95% CI) = −1.15 to 0.41; I2 = 96%; p = 0.35]. However, PRP showed statistically significant improvements in VAS scores at 6 months (SMD = −1.92; 95% CI = −3.33 to −0.51; I2 = 98%; p = 0.008) and 1 year (SMD = −0.37; 95% CI = −0.70 to −0.03; I2 = 0%; p = 0.03). For function, PRP resulted in significant improvements in American Orthopaedic Foot & Ankle Society (AOFAS) scores at 6 months (SMD = 0.89; 95% CI = 0.09 to 1.69; I2 = 94%; p = 0.03) but not at 3 months (SMD = −0.09; 95% CI = −0.63 to 0.44; I2 = 86%; p = 0.73) or 1 year (SMD = 1.68; 95% CI = −0.09 to 3.45; I2 = 96%; p = 0.06). Conclusion: Platelet-rich plasma is more effective than corticosteroid injections for pain control from 6 months to 1 year. In the short term, PRP offers no significant advantage. Interpretation of these findings should consider the quality of studies, risk of bias, and variability in PRP preparation protocols, which affect the internal and external validity. Thus, compelling evidence for PRP's superiority in PF treatment remains elusive.

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  1. Irving DB, Cook JL, Young MA, et al. Impact of chronic plantar heel pain on health-related quality of life. J Am Podiatr Med Assoc 2008;98(4):283–289. DOI: 10.7547/0980283
  2. Neufeld SK, Cerrato R. Plantar fasciitis: evaluation and treatment. J Am Acad Orthop Surg 2008;16(6):338–346. DOI: 10.5435/00124635-200806000-00006
  3. Chuckpaiwong B, Berkson EM, Theodore GH. Extracorporeal shock wave for chronic proximal plantar fasciitis: 225 patients with results and outcome predictors. J Foot Ankle Surg 2009;48(2):148–155. DOI: 10.1053/j.jfas.2008.11.001
  4. 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(1):3–9. DOI: 10.1007/s12178-008-9036-1
  5. Desouza C, Dubey R, Shetty V. Platelet-rich plasma in chronic Achilles tendinopathy. Eur J Orthop Surg Traumatol 2023;33(8):3255–3265. DOI: 10.1007/s00590-023-03570-6
  6. Lädermann A, Zumstein MA, Kolo FC, et al. In vivo clinical and radiological effects of platelet-rich plasma on interstitial supraspinatus lesion: case series. Orthop Traumatol Surg Res 2016;102(8):977–982. DOI: 10.1016/j.otsr.2016.09.010
  7. Desouza C, Shetty V. Effectiveness of platelet-rich plasma in partial-thickness rotator cuff tears: a meta-analysis. J ISAKOS 2024;9:699–708. DOI: 10.1016/j.jisako.2024.04.010
  8. Aurégan JC, Klouche S, Levy B, et al. Autologous conditioned plasma for tendon healing following arthroscopic rotator cuff repair. Prospective comparative assessment with magnetic resonance arthrography at 6 months’ follow-up. Orthop Traumatol Surg Res 2019;105(2):245–249. DOI: 10.1016/j.otsr.2019.01.003
  9. Shetty V, Desouza C. Catastrophic complication after intra-articular injection of platelet-rich plasma—case report. J Orthop Rep 2024;3(1):100254. DOI: 10.1016/j.jorep.2023.100254
  10. Lyras DN, Kazakos K, Agrogiannis G, et al. Experimental study of tendon healing early phase: is IGF-1 expression influenced by platelet rich plasma gel? Orthop Traumatol Surg Res 2010;96(4):381–387. DOI: 10.1016/j.otsr.2010.03.010
  11. Corbett MS, Higgins JP, Woolacott NF. Assessing baseline imbalance in randomised trials: implications for the Cochrane risk of bias tool. Res Synth Methods 2014;5(1):79–85. DOI: 10.1002/jrsm.1090
  12. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.9. Updated March 2011. The Cochrane Collaboration. https://training.cochrane.org/handbook/current
  13. Higgins JPT, Thomas J, Chandler J, et al. Cochrane Handbook for Systematic Reviews of Interventions. 2nd edition. Chichester (UK): John Wiley & Sons, 2019.
  14. Page MJ, McKenzie JE, Bossuyt PM. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev 2021;10(1):89. DOI: 10.1186/s13643-021-01626-4
  15. Sharma R, Chaudhary NK, Karki M, et al. Effect of platelet-rich plasma versus steroid injection in plantar fasciitis: a randomized clinical trial. BMC Musculoskelet Disord 2023;24:172. DOI: 10.1186/s12891-023-06277-1.
  16. Khurana A, Dhankhar V, Goel N, et al. Comparison of midterm results of platelet rich plasma (PRP) versus steroid for plantar fasciitis: a randomized control trial of 118 patients. J Clin Orthop Trauma 2021;13:9–14. DOI: 10.1016/j.jcot.2020.09.002
  17. Shetty SH, Dhond A, Arora M, et al. Platelet-rich plasma has better long-term results than corticosteroids or placebo for chronic plantar fasciitis: randomized controlled trial. J Foot Ankle Surg 2019;58(1):42–46. DOI: 10.1053/j.jfas.2018.07.006
  18. Peerbooms JC, Lodder P, den Oudsten BL, et al. Positive effects of platelet-rich plasma on pain in plantar fasciitis. Am J Sports Med 2019;47(13):3238–3246. DOI: 10.1177/0363546519877181
  19. Jimenez-Perez AE, Gonzalez-Arabio D, Diaz AS, et al. Clinical and imaging effects of corticosteroids and platelet-rich plasma for the treatment of chronic plantar fasciitis: a comparative non randomized prospective study. Foot Ankle Surg 2019;25(3):354–360. DOI: 10.1016/j.fas.2018.01.005
  20. Upadhyay S, Damor V. Autologous platelet rich plasma versus corticosteroid injection for chronic plantar fasciitis: a prospective controlled randomized comparative clinical study. Int J Res Med Sci 2018;6(5):1–6. DOI: 10.18203/2320-6012.ijrms20181430
  21. Jain SK, Suprashant K, Kumar S, et al. Comparison of plantar fasciitis injected with platelet-rich plasma vs corticosteroids. Foot Ankle Int 2018;39(7):780–786. DOI: 10.1177/1071100718762406
  22. Uğurlar M, Sönmez MM, Uğurlar OY, et al. 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 2018;57(5):913–918. DOI: 10.1053/j.jfas.2018.03.017
  23. Acosta-Olivo C, Elizondo-Rodriguez J, Lopes-Cavazos R, et al. Plantar fasciitis: a comparison of treatment with intralesional steroids versus platelet rich plasma. A randomized, blinded study. J Am Podiatr Med Assoc 2017;107(6):490–496. DOI: 10.7547/15-125
  24. Vahdatpour B, Sajadieh S, Bateni V, et al. Beneficial effects of platelet-rich plasma on improvement of pain severity and physical disability in patients with plantar fasciitis: a randomized trial. Adv Biomed Res 2016;5:84. DOI: 10.4103/2277-9175.192731
  25. Mahindra P, Yamin M, Selhi HS, et al. Chronic plantar fasciitis: effect of platelet-rich plasma, corticosteroid and placebo. Orthopedics 2016;39(2):e285–e289. DOI: 10.3928/01477447-20160222-01
  26. Sherpy N, Hammad MA, Hagrass HA, et al. Local injection of platelet rich plasma compared to corticosteroid treatment of chronic plantar fasciitis patients: a clinical and ultrasonographic follow-up study. Egyp Rheumatol 2016;38(3):247–252. DOI: 10.1016/j.ejr.2015.09.008
  27. Jain K, Murphy PN, Clough TM. Platelet rich plasma versus corticosteroid injection for plantar fasciitis: a comparative study. Foot Edinb 2015;25(4):235–237. DOI: 10.1016/j.foot.2015.08.006
  28. Pinsker E, Daniels TR. AOFAS position statement regarding the future of the AOFAS clinical rating systems. Foot Ankle Int 2011;32:841–842. DOI: 10.3113/FAI.2011.0841
  29. Yoo SD, Kim HS, Lee JH, et al. Biomechanical parameters in plantar fasciitis measured by gait analysis with pressure sensor. Ann Rehabil Med 2017;41(6):979–989. DOI: 10.5535/arm.2017.41.6.979
  30. Chang R, Rodrigues PA, Van Emmerik RE, et al. Multi-segment foot kinematics and ground reaction forces during gait of individuals with plantar fasciitis. J Biomech 2014;47(11):2571–2577. DOI: 10.1016/j.jbiomech.2014.06.003
  31. Ling Y, Wang S. Effects of platelet-rich plasma in the treatment of plantar fasciitis: a meta-analysis of randomized controlled trial. Medicine (Baltimore) 2018;97(37):e12110. DOI: 10.1097/MD.0000000000012110
  32. Yang WY, Han YH, Cao XW, et al. Platelet-rich plasma as a treatment for plantar fasciitis: a meta-analysis of randomized controlled trials. Medicine (Baltimore) 2017;96(44):e8475. DOI: 10.1097/MD.0000000000008475
  33. Singh P, Madanipour S, Bhamra JS, et al. A systematic review and meta-analysis of platelet-rich plasma versus corticosteroid injections for plantar fasciopathy. Int Orthop 2016;41(6):1169–1181. DOI: 10.1007/s00264-017-3470-x
  34. Whittaker GA, Munteanu SE, Menz HB, et al. Corticosteroid injection for heel pain: a systematic review and meta-analysis. BMC Musculoskelet Dis 2019;20(1):378. DOI: 10.1186/s12891-019-2749-z
  35. Aksahin E, Dogruyyol D, Yüksel HY, et al. The comparison of the effect of corticosteroids and platelet-rich plasma (PRP) for the treatment of plantar fasciitis. Arch Orthop Traum Surg 2012;132:781–785. DOI: 10.1007/s00402-012-1488-5
  36. Davis PF, Severud E, Baxter DE. Painful heel syndrome: results of non-operative treatment. Foot Ankle Int 1994;15(10):531–535. DOI: 10.1177/107110079401501002
  37. Zhou X, Fragala MS, McElhaney JE, et al. Conceptual and methodological issues relevant to cytokine and inflammatory marker measurements in clinical research. Curr Opin Nutr Metab Care 2010;13(5):541–547. DOI: 10.1097/MCO.0b013e32833cf3bc
  38. Boswell SG, Cole BJ, Sundman EA, et al. Platelet-rich plasma: a milieu of bioactive factors. Arthroscopy 2012;28:429–439. DOI: 10.1016/j.arthro.2011.10.018
  39. Daheshia M, Yao JQ. The interleukin 1beta pathway in the pathogenesis of osteoarthritis. J Rheumatol 2008;35:2306–2312. DOI: 10.3899/jrheum.080346
  40. Kennedy MI, Whitney K, Evans T, et al. Platelet-rich plasma and cartilage repair. Curr Rev Musculoskelet Med 2018;11(4):573–582. DOI: 10.1007/s12178-018-9516-x
  41. Zhang JM, An J. Cytokines, inflammation, and pain. Int Anesthesiol Clin 2007;45(2):27–37. DOI: 10.1097/AIA.0b013e318034194e
  42. Amin I, Gellhorn AC. Platelet-rich plasma use in musculoskeletal disorders: are the factors important in standardization well understood? Phys Med Rehabil Clin N Am 2019;30(2):439–449. DOI: 10.1016/j.pmr.2018.12.005
  43. Taunton JE, Ryan MB, Clement DB, et al. A retrospective case-control analysis of 2002 running injuries. Br J Sports Med 2002;36(2):95–101. DOI: 10.1136/bjsm.36.2.95
  44. Kon E, Di Matteo B, Delgado D, et al. Platelet-rich plasma for the treatment of knee osteoarthritis: an expert opinion and proposal for a novel classification and coding system. Expert Opin Biol Ther 2020;20:1447–1460. DOI: 10.1080/14712598.2020.1798925
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