Foot & Ankle International - July 2018 - 780

762406
research-article2018

FAIXXX10.1177/1071100718762406Foot & Ankle InternationalJain et al

Article

Comparison of Plantar Fasciitis
Injected With Platelet-Rich Plasma vs
Corticosteroids

Foot & Ankle International®
2018, Vol. 39(7) 780-786
© The Author(s) 2018
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https://doi.org/10.1177/1071100718762406
DOI: 10.1177/1071100718762406
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Sumit Kumar Jain, MBBS, MRCS, MS(Ortho), MCh1, Kumar Suprashant, MBBS1,
Sanjeev Kumar, MBBS, MS(Ortho)1, Arun Yadav, MBBS, MS(Ortho)1,
and Stephen R. Kearns, MD, FRCS(Tr&Orth), FFSEM2

Abstract
Background: Plantar fasciitis is one of the most common causes of heel pain. This prospective study compared the
efficacy of local injection of corticosteroids vs platelet-rich plasma (PRP) in the treatment of plantar fasciitis.
Methods: Patients were randomly allocated into 2 groups of 40 each (group A and group B). Patients were treated
with local corticosteroid injection in group A and autologous PRP injection in group B. Clinical assessment was done
prior to the injection and at 1 month, 3 months, and 6 months following the injection, which included visual analog pain
scale, subjective rating using the modified Roles and Maudsley score, functional outcome score by the Foot and Ankle
Outcome Instrument (FAI) core scale, and the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale.
Radiological assessment was done by measuring the thickness of the plantar fascia using ultrasonography. The mean age,
sex, and body mass index of both groups were comparable.
Results: Postinjection, there was significant improvement of visual analog score, modified Roles and Maudsley score, FAI
core scale, AOFAS ankle-hindfoot score, and plantar fascia thickness in both the groups. However, with the numbers
available, no significant difference in improvement could be detected between the above-mentioned variables in the 2 groups.
Conclusion: We found that the treatment of plantar fasciitis with steroid or PRP injection was equally effective.
Level of Evidence: Level II, prospective randomized comparative series.
Keywords: heel, pain, platelet-rich plasma, steroid injection
Plantar fasciitis, which is often described as an overload of
the plantar fascia,16 is the most common cause of heel pain
in adults.37 It is characterized by gradual onset of sharp pain
along the medial aspect of the heel that is worse with the first
step taken in the morning or at the beginning of an activity
and lessens as the person warms up. The etiology of plantar
fasciitis is multifactorial and poorly understood. Poor biomechanics and variations in the structure of the foot30 can
lead to repeated microtrauma of the plantar fascia at its origin, resulting in inflammation and degeneration.6,25 Plantar
fasciitis is more prevalent in sedentary individuals and also
in athletes, as well as those participating in running sports.16
Pohl et al30 have shown that a lower arch height and greater
vertical ground reaction force load rate were associated with
a history of plantar fasciitis in female runners. The other risk
factors associated with plantar fasciitis include reduced
ankle dorsiflexion, increased body mass index (BMI), and
work-related weightbearing activities.24
Available treatments modalities for plantar fasciitis, such
as plantar fascia stretching exercises, strapping, extracorporeal shock wave therapy, nonsteroidal anti-inflammatory

drugs (NSAIDs), arch supports, and heel pads, are mainly
aimed to reduce inflammation. Corticosteroid injections are
often reserved for resistant plantar fasciitis after failure of
conservative noninvasive interventions. They have been
shown to effectively reduce the heel pain in patients with
plantar fasciitis.8,9,17 The potent anti-inflammatory effect of
corticosteroids may hasten the process of pain relief. They
can also inhibit fibroblast proliferation and ground substance proteins.23 However, the use of corticosteroid injections for the treatment of plantar fasciitis has been shown to
be associated with rupture of plantar fascia, infection,
change in skin pigmentation, peripheral nerve injury, muscle damage, postinjection flare, and fat pad atrophy.1,19,36,39

1

NDMC Medical College & Hindu Rao Hospital, Delhi, India
Galway University Hospitals, Galway, Ireland

2

Corresponding Author:
Sumit Kumar Jain, MBBS, MRCS, MS(Ortho), MCh, NDMC Medical
College & Hindu Rao Hospital, Malkaganj, Delhi, 110007, India.
Email: jainsumit24@gmail.com
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