FPIN's Clinical Inquiries
Platelet-Rich Plasma vs. Corticosteroids for Refractory Plantar Fasciitis
Am Fam Physician. 2021 Mar 1;103(5):307-308.
In patients with plantar fasciitis refractory to conservative therapies, do platelet-rich plasma injections improve pain and function compared with corticosteroid injections?
Platelet-rich plasma injections are similar to corticosteroids for pain relief and improvement in function in patients with refractory plantar fasciitis lasting less than 12 weeks. (Strength of Recommendation [SOR]: B, based on inconsistent and low- to moderate-quality evidence.) Platelet-rich plasma injections may provide greater pain relief and improvement in function than corticosteroid injections in refractory plantar fasciitis lasting more than 12 weeks. (SOR: B, based on two meta-analyses of randomized controlled trials [RCTs] and two RCTs.)
A 2019 systematic review and meta-analysis compared corticosteroid therapy with several other treatments in patients with plantar fasciitis in whom conservative therapy was ineffective. The review included a subgroup analysis of eight RCTs comparing corticosteroid injections with platelet-rich plasma injections (n = 405).1 In the short (up to six weeks) and medium (seven to 12 weeks) terms, both treatments had a similar effect on pain and function. In the long term (13 to 52 weeks), corticosteroid and platelet-rich plasma were still similar in functional impact, but platelet-rich plasma was more effective for pain relief. The difference in pain response was reported to be clinically significant (standardized mean difference = 0.61; 95% CI, 0.16 to 1.06).
A 2017 meta-analysis of nine RCTs (n = 430) compared platelet-rich plasma injections with corticosteroid injections.2 At four and 12 weeks, no significant differences were noted between the groups. At 24 weeks, platelet-rich plasma was more effective than corticosteroids at reducing pain scores on a 10-point visual analog scale (VAS; weighted mean difference = −0.95; 95% CI, −1.80 to −0.11; P = .03; I2 = 85%). There were no differences between the two
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Referencesshow all references
1. Whittaker GA, Munteanu SE, Menz HB, et al. Corticosteroid injection for plantar heel pain: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2019;20(1):378....
2. 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.
3. Peerbooms JC, Lodder P, den Oudsten BL, et al. 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.
4. Landorf KB, Radford JA. Minimal important difference: values for the Foot Health Status Questionnaire, Foot Function Index and Visual Analogue Scale. Foot. 2008;18(1):15–19.
5. 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 control trial. J Foot Ankle Surg. 2019;58(1):42–46.
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