Platelet Rich Plasma versus Corticosteroid and Bupivacaine Injections in Plantar Fasciitis: A Prospective Study
Naveen Malhotra, Arun Kumar, Sanjay Johar, Neha Sinha, Amit Kumar, Gaurav SharmaBackground and Aims:
Plantar fasciitis (PF) is a localized inflammation and degeneration of the plantar aponeuroses, which commonly presents as heel pain. A calcaneal or heel spur is a frequent finding in about 50% of the patients. We compared the efficacy of injection of platelet-rich plasma (PRP) with a combination of local anaesthetic and steroid in patients with PF with regard to pain relief, functional improvement, and any side effects.
Materials and Methods:
Fifty patients diagnosed with PF who failed to respond to 6 weeks of conservative treatment were divided into two groups of 25 each: Group I patients were administered fluoroscopy-guided injection of 5 ml 0.25% bupivacaine and 1 ml of triamcinolone (40 mg) and Group II patients were administered fluoroscopy-guided injection of 6 ml PRP. Outcome assessment was done with evaluation of pain score using the Numeric Rating Scale (NRS, 0-10), functional disability using Foot and Ankle Disability Index (FADI), patient satisfaction, and side effects.
Results:
Demographic variables were comparable in both the groups. There was a significant improvement in NRS and FADI after injection in both the groups at all-time intervals. Both groups were comparable at baseline. Group I showed greater short-term reduction in pain and higher satisfaction at 30 min and 2 weeks, but outcomes declined over time. Group II demonstrated slower initial improvement, yet showed superior and sustained pain relief, functional recovery (FADI), and satisfaction up to 12 months post intervention. Adverse effects included transient pain during injection and short-lived soreness, with no major complications reported in either group throughout follow-up.
Conclusion:
Fluoroscope-guided injection of corticosteroids with bupivacaine and PRP are safe and effective technique for the management of symptomatic PF. Both these techniques provide good pain relief and improvement in physical disability to the patients; however, injection of PRP provides a sustained and longer improvement.