Clinical response to cortisone or platelet-rich plasma (PRP) injection in plantar fasciitis with MRI: Randomised, double-blinded trial.
Musculoskeletal problems are a huge growing concern within medicine, and can lead to significant impacts on either sport or society as a whole. Broadly speaking, musculoskeletal medicine can be broken down into acute or chronic pain and disability. Then further separated into causes based on mechanical, inflammatory or degenerative causes. Ultimately, the primary focus within musculoskeletal medicine and injury is to reduce pain, restore functional capacity, and preserve maintain tissue health.
Obviously, musculoskeletal pain injury is very wide. In this particular case, we would like to hone in on a recent 2021 double-blind a trial on plantar fasciitis. Plantar fasciitis is very a common problem which is the leading cause of acute and chronic heel pain. Common treatment options for the treatment of plantar fasciitis includes non-steroidal anti-inflammatory drugs, foot orthotics, biomechanical support, stretching and avoidance of excessive exercise, correction of imbalances and manual therapy (physiotherapy and osteopathy).
The most common MRI findings in plantar fasciitis are thickening of the insertional soft tissue (over 4mm) and hyper signalling. These are characteristically related to inflammatory remodeling and microtrauma. Additional treatment options consist of cortisone (steroid) or platelet-rich plasma (PRP) injection, we do not personally recommend the use of shockwave therapy. Cortisone injection treatment within musculoskeletal medicine is currently considered as a second-line treatment option in patients with widespread inflammation and persistent pain over three months, but this is not a long-term solution and often leads to a high recurrence rate with an increased risk of tissue degradation and consequently rupture. Here at Dynamic Osteopaths & Regenerative Medicine with prefer to avoid steroid as much as possible, and only administer if absolutely necessary. This is because we find that there is often a poor long-term outcome associated with cortisone injections. PRP injections on the other hand are increasingly used within musculoskeletal medicine, specifically in the treatment of joint, cartilage, tendon, ligament and insertional pathologies, especially in recurrent chronic disease and inflammation, tendon damage and degradation and/or resistance to conventional treatments. PRP is becoming increasingly popular within sports medicine and musculoskeletal medicine in general, due to its effectiveness, but at the same time being safe, natural and very well tolerated with minimal side-effects. Many studies now when looking at comparisons between the two treatments are finding better efficacy of PRP over cortisone, particularly in the long term.
The purpose of this new study was to identify association between MRI features and clinical assessment at start and six months following injection treatment in patients with plantar fasciitis, and to identify initial MRI criteria associated with a favorable clinical response to treatment. PRP injections are increasingly used in musculoskeletal medicine to treat many conditions, and many authors have documented the effectiveness of PRP treatment in patients with degenerative cartilage damage come often seen in osteoarthritis.
To conclusion, this study identified that PRP injections are effective in a large number of patients with plantar fasciitis regardless fascial thickness. However, with cortisone injections, a marked initial thickness was closely associated with a favourable clinical outcomes only. This study therefore suggests that the therapeutic plan should be oriented towards second-line treatment with PRP over steroid.
Study found here.
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Don’t let pain, back pain, joint damage, sports injuries or arthritis get in the way of allowing you to do what you want. Schedule a consultation at Dynamic Regenerative Medicine today, and let us treat your injury, provide pain relief and get you back to your full and active lifestyle. We have clinics operating out of Solihull (Henley-In-Arden) and Birmingham (Edgbaston).
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