• Adam Whatley

Plantar Fasciitis Treatment: cortisone or PRP injection?



Plantar Fasciitis Treatment: cortisone or PRP injection?

Plantar fasciitis is a very common musculoskeletal condition within orthopaedic practice. This can lead to chronic heel pain and reduced quality of life. Plantar fasciitis, was previously considered an acute inflammatory condition, but is now understood to be a chronic degenerative process with or without inflammation.


Rest, stretching, orthotics, non-steroidal anti inflammatory drugs, shock wave therapy, corticosteroids injections, botox, prolotherapy, platelet-rich plasma (PRP) and surgery are most used in the treatment and management of the condition. The majority of patients get better with non-surgical treatment. Heal osteophyte formation (heel spurs) and thickened plantar fascia can also be some of the typical imaging findings associated with chronic Planter Fasciitis. Needless to say, this condition can be hugely debilitating and difficult to treat.


The non-surgical treatment which offers the best safety and efficacy in treating plantar fasciitis still remains undetermined. The release of plantar fascia surgically is not very common anymore. In cases of stubborn plantar fasciitis that do not adequately respond to conservative modalities of treatment are offered corticosteroids (cortisone) injection treatment. Although being relatively good at reducing pain, this pain relief can often be short lived and can come with complications, such as tissue weakening and rupture. Platelet-rich plasma (PRP) on the other hand, he is becoming increasingly more popular for the successful treatment of acute and chronic Planter Fasciitis. PRP treatment works by facilitating and enhancing the healing process. The tissue repair due to PRP is mediated by biological cytokines and growth factors. Clinically, PRP is widely used for many soft tissue injuries, nerve injuries, cardiac tissue injury, tendinitis, skin and osteoarthritis. There is a significant rise in the popularity for the usage of growth factor containing plasma, for treating various injury, pain and inflammatory conditions.


PRP is a very popular treatment for plantar fasciitis to reduce heel pain and to restore function. The purpose of this recent study is to assess the effectiveness and safety of PRP treatment for plantar fasciitis. Ultrasound is used in this study to measure the thickness of the plantar fascia based on two different treatments options - corticosteroid (cortisone) and PRP injection. In this study, significant improvement was seen in the PRP injection group when compared with the steroid group. Although steroid can show initial improvements in pain reduction, for long-term effects - the PRP treatment provides better clinical outcomes when compared to the corticosteroid group. Furthermore, complications were minimal in the PRP group in comparison with the steroid group, and ultrasound measurements of plantar fascia thickness in PRP vs steroid groups are shown in Figure 6 and Figure 7.



Plantar Fasciitis Treatment: cortisone or PRP injection?


Plantar Fasciitis Treatment: cortisone or PRP injection?


This comparison study concluded that there findings prove that PRP injection treatment is a very good method of treating and managing patients with chronic plantar fasciitis with more than three months symptom duration, a pain score of over 6 out of 10, plantar fascia thickness of 5 mm and failed conservative treatment. This is further evidenced by a comparison done by ultrasound imaging of the plantar fascia thickness before and after the procedure. This study identified better results with PRP injection compared to the local steroid injection treatment. Also, this is the largest case, compared to the previously available studies in the literature. PRP therapy may be used as a better alternative to the treatments available currently for chronic heel pain, with better long term outcomes.


See study here: A Prospective Study Comparing the Efficacy of Local Injection of Platelet-Rich Plasma (PRP) vs Methylprednisolone in Plantar Fasciitis (July 2022).



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