Joost Peerbooms

103 PRP in plantar fasciitis BACKGROUND Chronic plantar fasciitis is the most common cause of foot complaints in the United States. Up to 11 to 15% of these complaints require professional care among adults. 6,21 The incidence of plantar fasciitis peaks in persons between the ages of 40 to 60 years with no bias towards either sex. 30 The underlying condition that causes plantar fasciopathy is a degenerative tissue condition that occurs near the site of origin of the plantar fascia at the medial tuberosity of the calcaneous. 3 In acute cases, plantar fasciitis is characterized by classical signs of inflammation including pain, swelling, and loss of function. For more chronic conditions, however, inflammation is not the underlying tissue disruption. In fact, histology of chronic cases has shown no signs of inflammatory cell invasion into the affected area. 16 Instead, the tissue is characterized histologically by infiltration with macrophages, lymphocytes, and plasma cells; tissue destruction; and repair involving immature vascularization and fibrosis. 16 The normal fascia tissue is replaced by an angiofibroblastic hyperplastic tissue, which spreads itself throughout the surrounding tissue creating a self-perpetuating cycle of degeneration. 16 Numerous methods have been advocated for treating plantar fasciitis, including rest, nonsteroidal anti-inflammatory medication, night splints, foot orthosis, stretching protocols, and extracorporeal shock wave therapy. 6,7,25,33 Corticosteroid injections are a popular method of treating the condition as well, but only seem to have small and short-term effects. 7 Other various types of surgical procedures have also been recommended. 1,6,8,19,29,33 The use of corticosteroids is particularly troubling since several studies have linked plantar fascia rupture to repeated local injections of a corticosteroid. 1,6,15,27 When neither rest and neither activity restriction nor conservative treatments result in a satisfactory outcome, the patient is often interested in treatment options other than surgery. Platelet-rich plasma (PRP) is promoted as an ideal autologous biological blood-derived product, which can be exogenously applied to various tissues where it releases high concentrations of platelet derived growth factors that enhance wound healing, bone healing, and tendon healing. 9,32 When platelets become activated, growth factors are released and initiate the body’s natural healing response. 34 In animals, the addition of growth factors to the ruptured tendon has been shown to increase the healing of the tendon. 8 In humans, it has been shown that the injection of platelets into the tendon decreases pain. 6 In a double-blind randomized trial, we investigated whether an injection of PRP improves the outcome of patients with chronic plantar fasciitis more so than corticosteroid 7