Joost Peerbooms

114 Chapter 7 Table 4 Improvement in the FFI Pain Scores by 25% α 25% Improvement in FFI pain, b n (%) Total Yes No Treatment group PRP 39 (84.8) 7 (15.2) 46 Control 20 (55.6) 16 (44.4) 36 Total 59 23 82 α For both the PRP group and the control group, the number (percentages) of patients showing a 25% improvement in their FFI Pain scores between baseline and the 12-month follow-up. FFI, Foot Function Index; PRP, platelet-rich plasma. b Patients in the PRP group showed a 25% improvement in the FFI Pain score significantly more often than patients in the control group ( χ 2 [1], 8.55; P = .003; odds ratio, 4.46; 95% CI, 1.58-12.66). DISCUSSION This randomized study was designed to test the effectiveness of PRP compared with corticosteroid injections for chronic plantar fasciitis. There is no standard of care management for chronic recalcitrant plantar fasciitis that is nonresponsive to nonoperative treatment. Many researchers believe that, since plantar fasciitis is a degenerative disease, regenerative potential of platelet rich plasma could help. The treatment of a degenerative tendon disease with an injection of concentrated autologous platelets may be a nonoperative alternative. By utilizing the GPS system, the patient’s own platelets can be collected into a highly concentrated formula. We postulate that the concentrated growth factors work in a synergetic manner to initiate a tendon healing response. This hypothesis is supported by in vitro research in the literature. Transforming growth factor β1 is shown to significantly increase type I collagen production by tendon sheath fibroblasts. This same mechanism is likely to be active in chronic plantar fasciitis. 34 In this study, we followed the patients for 1 year after intervention; pain at the end of 1 year was our primary end point, as assessed with the FFI Pain scale. Function and quality of life were the secondary outcome measures. Our results show that the 2 treatments differed in their change in pain score over time. Patients in the PRP group showed significantly lower pain and disability scores than patients in the control group after adjusting for baseline differences. Differences between the treatment groups at 1-year follow-up were not found with respect to function (FFI Activity and AOFAS) and quality of life (WHOQOL-BREF). A larger percentage of patients showed at least a 25% improvement in pain score between baseline and the 1-year follow-up in the PRP group (84.8%) than in the control group (55.6%). Our findings in this study with a decrease in the pain and disability after a PRP injection compared well with other published studies on treatment of plantar fasciitis. 29 It also showed similar outcomes