People with plantar fasciitis often worry about long-term effects like decreased mobility and chronic foot pain. That’s why new treatments for plantar fasciitis have been developed and these include platelet rich plasma injections as well as extracorporeal shockwave therapy. The purpose of these treatments are to not only reduce pain and symptoms, but to potentially fix the problem and prevent plantar fasciitis from getting worse. But which of these two treatments is better? Let’s review data from a recent clinical trial that compared these newer treatment options.
Plantar fasciitis is a condition that causes pain in the heel. It is often caused by overuse or strain on the plantar fascia, which can then lead to damage. Most cases of plantar fasciitis can be treated with a combination of stretching, arch support, physical therapy, and home exercises. These methods can help improve flexibility and relieve tension on the plantar fascia. However, if these options don’t work and you still have persistent pain, you may want to consider newer treatments such as platelet rich plasma injections or extracorporeal shockwave therapy.
PRP, or platelet-rich plasma injections, is a treatment that uses a patient's own blood to help heal the plantar fascia. PRP is believed to work by releasing growth factors that promote healing. Extracorporeal shockwave therapy is a treatment that uses sound waves to stimulate healing and promote tissue regeneration. The sound waves are delivered to the affected area using a handheld device.
This recent clinical trial was a retrospective study that evaluated and compared clinical outcomes of chronic plantar fasciitis treated with platelet rich plasma as well as extracorporeal shockwave therapy. The authors enrolled 55 consecutive patients with a minimum of two years follow up. There were 28 patients in the PRP group and 27 patients in the shockwave group.
With regards to the PRP group, the authors report that average platelet concentration in each injection was 2-3 times greater than that of whole blood. Injections were done with ultrasound guidance once a week for three weeks. Patients were instructed to avoid NSAID medications during treatment and at least 2 weeks after the last injection.
For the shockwave group, focal extracorporeal shockwave was administered with ultrasound guidance. Up to 5 treatments were administered at 1 to 2 week intervals using a low to medium energy level compatible with each patients’ pain tolerance. A total of 1000 impulses were administered for each session. The mean number of treatments was 4.6 in the shockwave group. Both groups were instructed to stop sporting or heavy physical activities during the treatment period. They were then instructed to gradually return to normal physical activity.
The authors report that both the PRP group and the shockwave group demonstrated a significant improvement from baseline to final follow up in all outcome measures. Satisfaction levels were similar between both groups. No patients required surgery during the follow up. However, the overall failure rate was higher in the shockwave group at 11% whereas it was 0% in the PRP group. Among athletes, the mean time to return to sport was significantly faster in the PRP group with a return to play at 3 months when compared to the shockwave group with a return to play at 6 months.
The authors go on to conclude that “PRP injections and extracorporeal shockwave therapy are both reliable and effective solutions for the treatment of plantar fasciitis at 2 years. However, patients treated with PRP required significantly less visits, less additional interventions, and showed faster return to physical activities.”
Ok so what are my takeaways from this study? This clinical trial was the first to my knowledge that directly compared outcomes between PRP injections and extracorporeal shockwave and it looks like PRP injections may be more effective.
However, I would argue that the results for the PRP group could have been even better. The authors’ PRP protocol involved drawing 450 cc of blood that was then processed and then separated into four shares for cryopreservation. It seems like the idea was to bank some of their PRP. But they didn’t end up using all of it for treatment. They administered a small amount of PRP each time which by my calculations came out to around 2 to 3 billion platelets per treatment.
People who follow closely with my channel know that platelet count and concentration are critically important for PRP treatment outcomes. This study administered 2-3 billion platelets per injection for three injections. This comes out to a total of 6-9 billion platelets. Newer PRP preparations and kits can give 8-10 billion platelets in one injection. This means that, instead of giving three injections, you can potentially get the same results with just one injection. Alternatively, you may get even better results if you administer three PRP injections each with 8-10 billion platelets.
Overall, I think it’s important to point out that the study found that both treatments worked really well to help those who suffer from chronic plantar fasciitis. Ultimately, we need more randomized controlled trials to determine which one is more effective. But until then, it will be important to discuss the pros and cons of each treatment with your healthcare provider and decide which one is best for you.