FPIN's Clinical Inquiries

Platelet-Rich Plasma vs. Corticosteroids for Refractory Plantar Fasciitis

 

Am Fam Physician. 2021 Mar 1;103(5):307-308.

Clinical Question

In patients with plantar fasciitis refractory to conservative therapies, do platelet-rich plasma injections improve pain and function compared with corticosteroid injections?

Evidence-Based Answer

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.)

Evidence Summary

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

Address correspondence to Aaron Vaughan, MD, at aaron.vaughan@mahec.net. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


Copyright © Family Physicians Inquiries Network. Used with permission.

References

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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.

Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (https://www.cebm.net).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to https://www.fpin.org or email: questions@fpin.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of FPIN's Clinical Inquiries published in AFP is available at https://www.aafp.org/afp/fpin.

 

 

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