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Dr. Pitts discusses PRP for Plantar Fasciitis, how it compares to steroid injections, and 3 studies of PRP.
 

Transcript

 

Hello everybody, this is Dr. John Pitts from the Centeno-Schultz Clinic. Today, I’d like to talk about PRP for plantar fasciitis. So, in short: yes, PRP can be used for plantar fasciitis. But let’s talk about –

 

What Is Plantar Fasciitis?

 

So plantar fasciitis is a painful heel, foot-type of pain condition where the fascia that attaches to the bottom of your heel – on the bottom of your foot – can get irritated, inflamed or injured or partially torn. This can happen from overuse, can happen when you have subtle issues in your low back, which most doctors do not know to look for – but we do here. And, also, it can result from just asymmetries in the way you move and weakness in the calf muscles, the hamstrings, etc.

 

So, when this occurs, you have pain at that heel, usually, it’s worst first thing in the morning, in the first few steps, and it can really limit your activity and ability to do things.

 

What Are the Treatment Options for Plantar Fasciitis?

 

So, usually, the first-line therapy is physical therapy. Good physical therapists will try to correct some of those biomechanical factors that led to the problem in the first place.

 

So, looking at your symmetry, looking at your gait, looking at your muscles, seeing if they can strengthen that, doing some stretches for the plantar fascia, to see if that loosens things up. There is a night splint that can be worn to help stretch things at night, which can be helpful for plantar fasciitis as well.

 

If those things fail to help alone, then there is an array of injection choices. So there are steroid injections, local anesthetic, PRP, prolotherapy, stem cell treatments, and there’s also an ultrasonic – what we call a needle tenotomy or Tenex – device that could be used to break up some of the bad tissue for plantar fascia as well.

 

So, today we are focused mostly on PRP. I am going to go through a few studies.

 

3 Studies on PRP for Fasciitis

 

One, in 2015, there was a comparative study of 60 patients who failed the physical therapy and conservative therapies. So they underwent either PRP versus steroid injection. So, after three months, both groups had made some improvements. But about six months and 12 months, the steroid group had worn off. So, it was just temporary relief and the PRP group was doing better and better and it maintained that benefit.

 

And so the fix lasted longer with PRP, even though steroids worked in the short term. There were no risks to the PRP, whereas when you inject steroids near or in the plantar fascia, there is a risk of actually damaging the plantar fascia, and make things worse. Also, steroids can kill off your local stem cells which help you to repair things, and they have a host of other side effects. PRP is just your own blood products that are used for repair.

 

Another study, in 2017, was a Meta-Analysis, which means they pulled a bunch of randomized controlled trials. They found nine studies so a total of 430 patients and basically showed similar results, where steroids, maybe were slightly better at three months of helping with pain. By the time he got to six months and more than a year, PRP was much better for long-term recovery.

 

There was another study. If you compare PRP to just dextrose prolotherapy – it was a very small study that showed that PRP improved the function in that patient more so than prolotherapy, though prolotherapy did help him out with the pain. So that is another option.

 

A patient should take from this is that you need to see a doctor that knows all the different treatment options because most doctors already know steroid injections or surgery when things come as the last resort. Most people want to avoid surgery, which you should because it has higher risk and more complications. And steroid injections can provide some short-term benefit, but not long-term benefit and don’t actually fix the underlying problem.

 

So, here at Centeno-Schultz Clinic, we specialize in that middle-ground, which is mostly we use PRP and stem cells but where we also can do prolotherapy. We also can use an ultrasonic device. And, so, there are subtleties in the type of injuries in the plantar fascia that we look for that would make us decide which option would probably be the best for you. And then also, you know, we take the time to figure out why do you have the plantar fascia problem in the first place.

 

And so, a lot of times we find some problems in the low back that could be addressed either with physical therapy or injections. And so we help with all the underlying causes, as well.

 

In summary, PRP for plantar fasciitis is certainly a great treatment option – has good evidence that it can be helpful. There are also some other non-invasive ways to help heal plantar fasciopathy, which, in more severe cases would be stem cells, maybe less severe cases would be prolotherapy, and in cases when the tendon is very thick, and maybe doing that ultrasonic Tenex device could be helpful as well.

 

Very rarely, if these things fail, you might need surgery as a last resort. If you just look for temporary pain relief, steroids can be an option. We try not to do that because we will not actually get the tissues to heal up and provide more long-term benefits.

 

Thanks for tuning-in. If you or anyone you know has plantar fascia problems or heel pain or any other musculoskeletal problem, we are experts at treating and diagnosing those problems and mostly trying to use regenerative methods.

 

Take care. Have a good day.

 

References:

1) https://www.sciencedirect.com/science/article/abs/pii/S0958259215000838

2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5682822/

3) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5682822/