Plantar Fasciitis is one of the most common cause of heel pain encountered in Orthopaedics OPD [1,2]. The most common presenting symptom of PF is a sharp pain of insidious onset with maximal tenderness at the anterior medial border of the calcaneus.[3] Plantar fasciitis affects both sedentary and athletic people and is thought to result from chronic overload either from lifestyle or exercise.[1]. Initially plantar fasciitis was believed to be an inflammatory process, it is now thought to be a degenerative condition and therefore termed as Plantar Fasciosis [4]. .Exact pathology of Plantar Fasciitis is not well understood but there is evidence that Plantar Fasciitis occurs due to repeated microtrauma leading to microscopic tears in the Plantar fascia. There is a combination of repeated opposing forces that act on fascia by the action of tendoachilles and the forefoot. This result in cellular damage exaggerated by vascularity. Various zones of hyperplasia and hypoplasia are developed in fascia [5]. Various treatment options are available to manage Plantar Fasciitis conservatively such as NSAIDS, Stretching exercises, night splinting, orthotics and extracorporeal shockwave therapy.[6]. Corticosteroid injection is used locally to treat Plantar Fasciitis but complications like fascia rupture are frequently associated [7,8]. This side effect is thought to be lesser with PRP (Platelet-rich plasma) due to its autologous nature.[9]. Various growth factors like platelet-derived growth factor, transforming growth factor, vascular endothelial growth factor, insulin-like growth factor and proteins like fibrin, fibronectin, vitronectin are found in PRP. This growth factor helps in soft tissue healing.[10]. Also, PRP stimulates local stem cells and inhibit apoptosis and metalloproteinase activity [11]. Moreover, in tendon recovery it stimulates tenocyte proliferation [12]. This study aimed to find the effectiveness of PRP injections in chronic Plantar Fasciitis.

The study was conducted at the Department of Orthopaedics, ABVGMC and associated hospital, Vidisha. It was a prospective observational study for a period of 18 months (August 2019 to February 2021). All patients with chronic Plantar Fasciitis age more than 18 years with a history of 4 weeks of unsuccessful conservative treatment visiting orthopaedics OPD were included in the study.

Injection technique- 3ml PRP solution directly injected into point of maximum tenderness of painful heel using Peppering technique with single skin entry portal. Post injection all patients were advised non-weight bearing for 24hours and tablet acetaminophen twice daily for 2 days. Gentle stretching exercises were advised before standing after prolonged rest on day 2 i.e. ball roll over-exercise, Plantar Fascia stretching exercises. All patients were examined at an interval of 4weeks, 8 weeks and 6-month post-injection for pain relief on the VAS scale (0-no pain, 10-worst pain).

A total of 60 patients were included in a study and were followed for 6 months. The age of patients ranged from 20 to 60 years with a mean age of 40 years. The maximum number of patient belonged to the age group 31 to 40 years. Among 60 cases, 21 were male and 39 were female (Graph -1). The right foot was involved in 28 cases and the left foot was involved in 32 cases. Upon analysis we found that there was a significant improvement in pain from 4 weeks post-injection. The Average VAS Score before PRP injection was 7.01±1.35, at 4weeks 5.13±1.32, at 8 weeks 4.2±1.31 and at 6 months 2.2±1.25 (Graph -2).

Table 1: showing mean VAS value.

The Average VAS score at follow up showed significant improvement in pain relief (Table- 1, p value<0.0001).

Graph 1: showing Sex distribution.

Graph 2: showing a decrease in average VAS value in follow up.

The study conducted by Paresh vilasrao et al [15]. in 60 patients showed excellent functional status in 97% of PRP treated Plantar Fasciitis. In Agreement with our study Gupta et al [16]. and El Mallah et al [17]. suggested PRP is a safe and effective line of treatment for chronic Plantar Fasciitis. Akram et al. [18]. concluded significant improvement in pain according to VAS score and Reduction in thickness of plantar fascia measured by ultrasonography. A metanalysis of RCT conducted by Wei Yi Yang et al [19]. showed PRP is superior to steroid treatment for long term pain relief but no significant difference was observed for short and intermediate effect. However, De Vas et al [20]. studied the effect of PRP in chronic tendinopathy. They concluded that there is no significant improvement of pain by PRP injection compared with saline injection. Similarly Sheath et al [21]. conducted a study to find the efficacy of autologous PRP used for Orthopaedic indications. They conclude the there is uncertainty about evidence in support of PRP used for Orthopaedic bone and soft tissue injuries. A possible explanation according to them is lack of standard study protocol, platelet separation technique and outcome measures. In a study conducted by Tiwari and Bhargava [22]. the cortisone group had a pretreatment mean VAS score of 8.5, which initially improved to 1.1 at 12 weeks posttreatment to at 26 weeks, and then continuously increased to near baseline levels of 8.4 at 52 weeks. In contrast, the PRP group started with an average pretreatment 8.6 scores decreased to 3.4 at 12 weeks, remained declining to 1.2 at 26 weeks, and 0.3 at 52 weeks.

We concluded that PRP injections provide symptomatic relief in reducing pain in patients with Plantar Fasciitis. There was a significant improvement in pain reduction according to the VAS score. So PRP therapy is an effective alternative to corticosteroid injection.

PRP injections provide symptomatic relief in reducing pain in patients with Plantar Fasciitis.

The authors would like to thank all the patients for participating in the study