Joost Peerbooms

106 Chapter 7 mL platelet concentrate is obtained for each patient. Autologous platelet concentrate contains concentrated white blood cells and platelets that are suspended in plasma. Since an acidic anticoagulant is introduced to the whole blood used to produce the platelet concentrate, the platelet concentrate must be buffered to increase the pH to normal physiologic levels. This was accomplished with 8.4% sodium bicarbonate solution added at a ratio 0.05 mL of sodium bicarbonate solution to 1 mL of platelet concentrate. The resulting buffered platelet concentrate contains approximately a 6 to 8 times concentration of platelets compared to baseline whole blood. No activating agent was used. The total time from blood draw to injection in the patients was about 30 minutes. No specialized equipment, other than the GPS machine, was required. Corticosteroid The type of steroid that is used during the study is kenacort 40 mg/mL triamcinolone acetonide. Injection Technique Initially, bupivacaine was infiltrated into the skin and the subcutaneous tissue of both groups as a local field block. Approximately 0.5 mL was also injected directly into the area of maximum tenderness. Then, either 5 to 6 mL platelet concentrate, or 1 mL corticosteroid was injected using a 22-gauge needle into the plantar fasciitis using a peppering technique. This technique involved a single skin portal and then 5 penetrations of the fascia. Postprocedure Protocol Immediately after injection, patients in both groups were kept in sitting position without moving the foot for 15 minutes. Patients were referred to the physiotherapist to obtain stretching exercises. Patients were sent home with instructions to limit their use of the feet for approximately 48 hours and they used hydrocodone or acetaminophen for pain. The use of nonsteroidal medication was prohibited. After 48 hours, patients were given a standardized stretching protocol to follow for 2 weeks. A formal strengthening program was initiated after this stretching. At 4 weeks after the procedure, patients were allowed to proceed with normal sporting or recreational activities as tolerated. Any type of foot orthoses was not allowed. Study Endpoints Pain The primary outcome measure pain was measured using a visual analogue scale score of the FFI at all time points. 4,14 The FFI pain score records the patient’s reported pain using a scale of 0 (pain-free) to 10 (worst pain imaginable). The scale is a 10-cm line, and the score is marked at the point on the line corresponding with the patient response.