Successful Treatment of Recalcitrant Plantar Fasciitis and Achilles Tendonitis using Platelet-Rich Plasma (PRP) Injection, Short and Intermediate Results

Abstract

Category: Basic Sciences/Biologics; Hindfoot Introduction/Purpose: PURPOSE: To identify is PRP is an effective alternative to surgery to decrease pain and increase activities for patients with recalitrant plantar faciiitis and Achilles tendonitis/tendonosis after failing greater than 6 months of appropriate conservative treatment. INTRODUCTION: PRP is thought to stimulate the body's natural mechanism of growth factors to promote healing of tissues. This is thought to occur through PRP transforming a chronic inflammatory degenerative process into a 'fresh' inflammatory process. Patients who undergo surgery for recalcitrant plantar fasciitis and Achilles tendonitis/tendonosis often have extended recovery time which can adversely affect employment status and lifestyle activities. The senior author began to use PRP is his orthopedic practice in 2015 as an alternative to surgery for patients with recalcitrant plantar fasciitis and Achilles tendonitis. Methods: From 2015 to 2020, patients with recalcitrant plantar fasciitis or Achilles tendonitis (symptoms >6 months and who had failed appropriate conservative measures) were given the choice to proceed with continued non-operative care vs. surgical intervention vs. a one-time PRP injection. All patients reported substantial pain affecting ADLs and recreational activities. All patients underwent preoperative MRI. Only patients with degenerative changes in the painful area on MRI were considered elegible for study inclusion. Informed consent was obtained for all participants prior to PRP injection. Subjects underwent a single PRP injection using a commercially avaialble FDA approved office based PRP centrifuge system. All PRP injections were performed by the senior author without ultrasound guidance using anatomical landmarks and the patient's maximum area of tenderness. Patient subjective assessments of success/failure of the injection and percentage of pain relief using VAS were recorded at 6-8 weeks and > 1 year post injection. Results: 89 PRP injections were performed on 88 patients (33 male/56 female). The Visual Analog Scale (VAS) was used to evaluate the treatment effectiveness along with the patient's subjective description of their improvement. Initial success was defined as >=50% pain decreased at 6-8 weeks post-injection. 55/89 subjects experienced relief >=50% at 6-8 weeks (overall 62% success rate). The average VAS improvement at 6-8 weeks was 67% for Achilles and 72% for plantar fasciitis (PF). 70 patients were available for intermediate follow-up (either in person or telephone) at an average of 27 months post-injection (range 13 - 41 months). For patients reporting >=50% continued pain relief, average VAS improvement was 83% for Achilles and 89% for PF. No patients with initial relief >=50% at 6-8 weeks had recurrent/worsened symptoms at intermediate follow-up. Patients with >=50% relief at 6-8 weeks trended toward further decreased pain over the next 12-24 months. Conclusion: This prospective case series study shows promising support of the short-term and intermediate-term effectiveness of PRP injection as a non-surgical treatment option for patients experiencing chronic recalcitrant plantar fasciitis and Achilles tendonitis. These results not only show a significant percentage of patients were able to avoid surgery with short term improvement in their symptoms, but the study also revealed that patients who experienced greater than 50% pain relief within the first 6 weeks after PRP injection, also showed continued improvement in their symptoms long term.