Soraganvi P, Nagakiran K V, Raghavendra-Raju R P, Anilkumar D, Wooly S, Basti B D, Janakiraman P
Department of Orthopaedics, PES Institute of Medical Sciences and Research Kuppam Campus, Kuppam, India.
Department of Community Medicine, PES Institute of Medical Sciences and Research Kuppam Campus, Kuppam, India.
Malays Orthop J. 2019 Nov;13(3):8-14. doi: 10.5704/MOJ.1911.002.
Plantar fasciitis is characterised by pain in the heel, which is aggravated on weight bearing after prolonged rest. Many modalities of treatment are commonly used in the management of plantar fasciitis including steroid injection. Many studies show that steroid injection provides pain relief in the short term but not long lasting. Recent reports show autologous platelet-rich plasma (PRP) injection promotes healing, resulting in better pain relief in the short as well as long term. The present study was undertaken to compare the effects of local injection of platelet-rich plasma and Corticosteroid in the treatment of chronic plantar fasciitis. Patients with the clinical diagnosis of chronic plantar fasciitis (heel pain of more than six weeks) after failed conservative treatment and plantar fascia thickness more than 4mm were included in the study. Patients with previous surgery for plantar fasciitis, active bilateral plantar fasciitis, vascular insufficiency or neuropathy related to heel pain, hypothyroidism and diabetes mellitus were excluded from the study. In this prospective double-blind study, 60 patients who fulfilled the criteria were divided randomly into two groups. Patients in Group A received PRP injection and those in Group B received steroid injection. Patients were assessed with visual analog scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) score. Assessment was done before injection, at six weeks, three months and six months follow-up after injection. Plantar fascia thickness was assessed before the intervention and six months after treatment using sonography. Mean VAS in Group A decreased from 7.14 before injection to 1.41 after injection and in Group B decreased from 7.21 before injection to 1.93 after injection, at final follow-up. Mean AOFAS score in Group A improved from 54 to 90.03 and in Group B from 55.63 to 74.67 at six months' follow-up. The improvements observed in VAS and AOFAS were statistically significant. At the end of six months' follow-up, plantar fascia thickness had reduced in both groups (5.78mm to 3.35mm in Group A and 5.6 to 3.75 in Group B) and the difference was statistically significant. Local injection of platelet-rich plasma is an effective treatment option for chronic plantar fasciitis when compared with steroid injection with long lasting beneficial effect.
足底筋膜炎的特征是足跟疼痛，长时间休息后负重时疼痛加剧。足底筋膜炎的治疗通常采用多种方法，包括类固醇注射。许多研究表明，类固醇注射在短期内可缓解疼痛，但效果不持久。最近的报告显示，自体富血小板血浆（PRP）注射可促进愈合，在短期和长期内均能更好地缓解疼痛。本研究旨在比较局部注射富血小板血浆和皮质类固醇治疗慢性足底筋膜炎的效果。临床诊断为慢性足底筋膜炎（足跟疼痛超过六周）且保守治疗失败、足底筋膜厚度超过4mm的患者纳入本研究。既往有足底筋膜炎手术史、双侧活动性足底筋膜炎、与足跟疼痛相关的血管功能不全或神经病变、甲状腺功能减退和糖尿病患者被排除在研究之外。在这项前瞻性双盲研究中，60例符合标准的患者被随机分为两组。A组患者接受PRP注射，B组患者接受类固醇注射。采用视觉模拟评分法（VAS）和美国矫形足踝协会（AOFAS）评分对患者进行评估。在注射前、注射后六周、三个月和六个月随访时进行评估。在干预前和治疗后六个月使用超声评估足底筋膜厚度。在最终随访时，A组的平均VAS评分从注射前的7.14降至注射后的1.41，B组从注射前的7.21降至注射后的1.93。在六个月的随访中，A组的平均AOFAS评分从54提高到90.03，B组从55.63提高到74.67。VAS和AOFAS评分的改善具有统计学意义。在六个月随访结束时，两组的足底筋膜厚度均有所减少（A组从5.78mm降至3.35mm，B组从5.6mm降至3.75mm），差异具有统计学意义。与类固醇注射相比，局部注射富血小板血浆是治疗慢性足底筋膜炎的有效选择，具有长期有益效果。
