PLANTAR FASCIITIS/FASCIOSIS: TREATMENT WITH ULTRASOUND-GUIDED INFILTRATIONS WITH PLATELET-RICH PLASMA (PRP)

PLANTAR FASCIITIS/FASCIOSIS: ULTRASOUND-GUIDED INFILTRATIONS WITH PLATELET-RICH PLASMA (PRP)
DR. JORDI JIMÉNEZ

The plantar fascia is a thin fibrous band of connective tissue that connects the heel to the base of the toes. The term plantar fasciitis refers to inflammation of this structure, while plantar fasciosis defines a degenerative change in the plantar fascia, with thickening, loss of its architectural pattern, sometimes with tears, increased vascularization, and constant, unsuccessful attempts at self-repair. All of these degenerative changes are precipitated by repeatedly subjecting the plantar fascia to biomechanical stress.

Associated with this condition is a calcaneal spur, a bony growth at the insertion of the plantar fascia that translates into excessive and prolonged traction on the plantar fascia (which the literature considers a consequence, not a cause, of heel pain in the vast majority of cases).

These degenerative changes are precipitated by repeatedly subjecting the plantar fascia to biomechanical stress.

Plantar fasciitis is the most common cause of heel pain, with a population prevalence of 10%. It is more common in women than in men. Risk factors include flat or hollow feet, excessive pronation of the foot, obesity, prolonged periods of standing, or shortened calves.

First-line treatment includes nonsteroidal anti-inflammatory drugs (NSAIDs), correction of poor plantar support with insoles, eccentric stretching, or extracorporeal shock wave therapy. These treatments are typically successful in 90% of cases. Intrafascial infiltration treatment with corticosteroids is and has been widely practiced and offers patient benefits due to its anti-inflammatory properties. It is controversial due to the risk of plantar fascia rupture and plantar pad atrophy. Perifascial ultrasound-guided infiltration (around the fascia and not within it) may reduce these complications. On the other hand, the benefit of corticosteroid infiltration is short-term, with no long-term benefits compared to placebo.

ULTRASOND-GUIDED INFILTRATIONS WITH PLATELET-RICH PLASMA (PRP)

Several authors have published reports on the use of platelet-rich plasma (PRP) in the treatment of plantar fasciitis/fascioses. As we have seen in other articles, PRP has anti-inflammatory and regenerative properties, mediated by the high concentration of platelet-derived growth factors and anti-inflammatory cytokines.

There are multiple publications comparing the use of PRP with other treatments such as corticosteroids, shock waves, or the patient's own whole blood. All of these studies attempt to evaluate which infiltration treatment is most beneficial in the short, medium, and long term.

Most of these publications agree that the use of PRP does not achieve significantly different results in the first three months of treatment, and it is not considered a superior treatment to other infiltration treatments in this period. On the other hand, there are published results regarding improved pain and function 6–12 months after starting treatment; therefore, in this time period, it could be superior to other infiltration treatments such as the patient's own whole blood or corticosteroids.

Again, the enormous variability in PRP preparation across publications (regarding preparation kits, addition of leukocytes to the final product, centrifugation, or PRP activation) hinders obtaining better scientific evidence for this treatment.

The use of ultrasound guidance is especially relevant in infiltration treatment with PRP. Prior detection of degenerative areas or fascial tears through ultrasound is essential to be able to direct PRP treatment to these injured areas.

 

Do you suffer from plantar fasciitis? Make an appointment with Dr. Jordi Jiménez. He will see you in the center of Palma de Mallorca and help you regain your quality of life.