Joost Peerbooms

102 Chapter 7 ABSTRACT Background: When conservative treatment for chronic plantar fasciitis fails, often a corticosteroid injection is given. Corticosteroid injection gives temporary pain reduction, but no healing. Platelet-rich plasma (PRP) has proven to be a safe therapeutic option in the treatment of tendon, muscle, bone, and cartilage injuries. Purpose: To determine the effectiveness of PRP compared with corticosteroid injections for chronic plantar fasciitis. Study design: Randomized controlled double-blind clinical trial. Methods: Patients with chronic plantar fasciitis were allocated to have steroid injection or PRP. The primary outcome measure was the Foot Function Index (FFI) pain score. Secondary outcome measures were function scored by the FFI Activity, FFI Disability and the American Orthopaedic Foot and Ankle Score (AOFAS) and quality of life scored with the WHOQOL-BREF. All outcomes were measured at baseline and at 4, 12, 26 weeks, and 1 year after the procedure. Results: Of the 115 patients, 63 were allocated to PRP group (of which 46 patients (73%) completed the study) and 52 were allocated to the control group (of which 36 patients (69%) completed the study). In the control group, FFI Pain scores decreased quickly and then remained stable during follow-up. In the PRP group, FFI Pain reduction was more modest, but reached a lower point after 12 months than the control group. After adjusting for baseline differences, the PRP group showed significantly lower pain scores at the 1-year follow-up than the control group (mean difference, 14.4; 95% CI, 3.2- 25.6). The number of patients with at least 25% improvement (FFI Pain score) between baseline and 12-month follow-up differed significantly between the groups. Of the 46 patients in the PRP group, 39 (84.4%) improved at least 25%, while only 20 (55.6%) of the 36 patients in the control group showed such an improvement ( p = 0.003). The PRP group showed significantly lower FFI Disability scores than the control group (mean difference, 12.0; 95% CI, 2.3-21.6). Conclusion: Treatment of patients with chronic plantar fasciitis with PRP seems to reduce pain and increase function more, compared to the effect of corticosteroid injection. Registration: NCT00758642 (ClinicalTrials.gov identifier). Key Words: Plantar fasciitis; Platelet Rich Plasma; Corticosteroids; Pain; Function.