SLR - June 2021 - Larry E. Milton
Reference: Hurley ET, Shimozono Y, Hannon CP, Smyth NA, Murawski CD, Kennedy JG. Platelet-Rich Plasma Versus Corticosteroids for Plantar Fasciitis: A Systematic Review of Randomized Controlled Trials. Orthop J Sports Med. 2020 Apr 27;8(4):2325967120915704.Level of Evidence: Level 1
Scientific Literature Review
Reviewed By: Larry E. Milton, DPM
Residency Program: Southern Arizona Veterans Affairs Health Care System – Tucson, AZ
Podiatric Relevance: The purpose of this study is to compare whether platelet-rich plasma (PRP) or corticosteroids (CS) injections result in decreased pain levels and improved patient outcomes for plantar fasciitis.
Methods: Two independent reviewers performed literature search using PRISMA guidelines. All studies in the Medline, EMBASE, and Cochrane Library databases were queried from their inception through September 2019 using the search words “Plantar Fasciitis or “Plantar Fascia” and “PRP, autologous blood, autologous conditioned plasma, or ACP”. Included research were randomized controlled trials published in peer reviewed journals with the comparison of PRP and CS having equivalent baseline outcome measures. All other articles that did not meet these criteria were excluded.
Outcome measures were scored on the visual analog scale (VAS) score for pain and the secondary measure was the American Orthopedic Foot and Ankle Society (AOFAS) score. The outcome measures were reported at 1, 1.5, 3, 6 and 12 months where possible and statistical analysis was performed.
Results: In all, nine clinical trials with 479 patients were included. In the PRP group, 239 patients were reviewed and 240 patients in the CS group. At one to 1.5 months, there was a statistically significant difference in the VAS scores in favor of PRP (six studies, 329 patients). At three months, there was a statistically significant difference in the VAS scores in favor of PRP (seven studies, 409 patients). At six months, there was a statistically significant difference in the VAS scores in favor of PRP (four studies, 279 patients). At 12 months, there was a statistically significant difference in the VAS scores in favor of PRP (two studies, 139 patients).
At 1-3 months, there was no statistically significant difference in the AOFAS scores between the two treatment groups. At six months, there was a statistically significant difference in the AOFAS scores in favor of PRP (three studies, 180 patients). At 12 months, there was a statistically significant difference in the AOFAS scores in favor of PRP (two studies, 100 patients).
Conclusions: This study suggests that PRP may lead to a greater improvement in pain and functional outcome as compared with CS injections for treatment of chronic plantar fasciitis. While CS have been and continue to be a mainstay in the treatment of patients with stubborn plantar fasciitis that has failed conservative treatment, PRP has shown promising results even compared to CS.