The biggest names in sports are doing it. Platelet rich plasma therapy (PRP therapy) has helped the likes of Tiger Woods, Kobe Bryant, and football player Hines Ward recover from injuries and return to the playing field. Resulting news coverage spurred wide interest in the general public about this emerging, little-understood, yet effective therapy. One of the greatest potential treatment options is PRP for plantar fasciitis pain.
What is PRP therapy?
PRP therapy is still considered on the cutting edge of medicine, and ongoing studies continue to shape treatment protocols. Mounting evidence is showing that PRP therapy is very effective for treating foot pain conditions, like plantar fasciitis, as well as knee osteoarthritis and a range of sports injuries.
Sports injuries can lead to lasting pain that other treatments stop short of completely healing. Increasing numbers of people are looking to cutting-edge therapies such as platelet rich plasma therapy to reduce pain, improve mobility, and return to the activities they once enjoyed. This video, from our own Dr. Tory McJunkin, gives a quick overview of PRP therapy and how PRP for plantar fasciitis may be a viable treatment option for many patients.
To make a platelet rich plasma preparation, patients initially have their blood drawn. Then, the blood is placed in a special piece of equipment called a centrifuge. This machinery spins very quickly and through the force of spinning—called centrifugal force—the platelets separate from the rest of the blood plasma, creating a preparation that contains anywhere from five to ten times the normal concentration of platelets.
The platelet rich plasma is then injected into the patient’s area of injury. For patients looking for PRP for plantar fasciitis, this would be into the foot itself. The entire process takes anywhere from one to two hours. Although one treatment is sometimes enough to benefit patients, other patients many need several injections. Doctors determine the course of treatment on a case-by-case basis.
What is the PRP injection recovery time?
After receiving a PRP injection, patients typically experience local pain and tenderness for a few days. Doctors may prescribe pain medication to lessen discomfort during healing. Patients should rest for about 24 hours after receiving the injections. Most people are ready to return to their normal activities after the day of rest.
Patients also typically undergo a physical therapy program once healed from pain or tenderness to complement the platelet rich plasma injection. Risks and complications from the procedure are minimal since the patient receives an injection of his or her own blood, and not a treatment derived from another person.
PRP for plantar fasciitis?
Plantar fasciitis is the most common form of chronic pain of the heel and foot in adults. Indeed, estimates suggest that one in every ten adults will experience plantar fasciitis in their lifetime.
Located on the bottom of the foot is a flat, thick connective tissue called the plantar fascia that serves to connect the ball of the foot to the heel and create support for the arch of the foot. When the plantar fascia becomes strained, damage can occur in the form of tiny tears within the ligament itself. Thus, the pain associated with plantar fasciitis is a result of damage to the plantar fascia ligament, inflammation, and compression of the surrounding tissue as a result of the inflammation.
PRP for plantar fasciitis seeks to undue this damage and help the body retain and increase its natural healing properties. This video from the University Foot and Ankle Institute shows how one patient received help from PRP for plantar fasciitis. It also gives a quick overview of what you can expect from the procedure.
What causes plantar fasciitis?
Plantar fasciitis is generally the result of strain to the plantar fascia. Strain or excess stretching can cause tiny tears in the ligament leading to inflammation and pain. Some patients with plantar fasciitis may describe the symptoms as having a sudden onset, while others report chronic difficulties with symptoms that have worsened over time.
Overuse and strain are the most common cause of injury to the plantar fascia ligament. Not completing a proper warm-up routine before engaging in physical activity or becoming involved in a new activity involving physical exertion after a significant period of time with little to no physical activity can place individuals at risk for damaging the plantar fascia ligament.
What are plantar fasciitis treatments?
Patients who have more mild cases of plantar fasciitis may successfully treat their condition with conservative interventions. Your pain doctor may recommend:
- Specified physical therapy exercises (such as plantar fasciitis stretches)
- Night splints to wear while sleeping
- Wearing shoes with adequate cushion and arch support
- Application of a cold compress twice a day for ten to 15 minutes
If these conservative treatments don’t work, or if your case of plantar fasciitis is more severe, your pain doctor may recommend PRP for plantar fasciitis. As discussed, this treatment option encourages the natural healing of the damaged area, in this case the foot.
Patients with plantar fasciitis that occurred as a result of an injury should not put too much strain on the feet for the first several days. Patients are strongly encouraged to allow ample time for full recovery. Full recovery may not be achieved for several weeks or even months. Though the patient may no longer be debilitated by symptoms of pain, stiffness, or weakness, the ligament may still not be fully healed.
What’s the research on PRP for plantar faciitis?
To read more of the research behind PRP for plantar fasciitis, check out these studies:
- A Podiatry Today study that posits that PRP for plantar fasciitis is a viable treatment option and alternative to surgery
- An early clinical study posted on the American Academy of Orthopaedic Surgeons website that shows that PRP for plantar fasciitis is more effective than an alternative treatment, cortisone shots
- A 2016 study from Orthopedics that showed significant improvement in patients who received PRP for plantar fasciitis
- A small-scale study published in International Orthopaedics that concluded that PRP for plantar fasciitis was a safe option with the potential for reducing pain
- A study in Foot & Ankle International that showed the benefits of using PRP for plantar fasciitis pain that hadn’t resolved from other treatments
- Another study from Techniques in Foot & Ankle Surgery that noted: “The augmented healing response facilitated by administration of PRP, its safety, and ease of use make this treatment attractive.”
What other conditions does PRP therapy treat?
PRP for plantar fasciitis is an especially interesting and viable area for study. However, platelet rich plasma therapy is being tested and used for a variety of other conditions including arthritis and muscle or tendon injuries.
Platelet rich plasma therapy offers great potential for treating knee arthritis, according to research published in the Clinical Journal of Sports Medicine. Patients included in the study experienced a 59% drop in pain, along with improved mobility and decreased inflammation. They also reported improved daily activity scores, which jumped by 56%.
73% of study participants experienced no progression of knee osteoarthritis, which researchers said was significant since arthritis tends to progress up to 6% each year. Patients were followed for a year, and their progress was assessed through magnetic resonance imaging (MRI) in addition to physical exams.
Researchers said the injection encouraged stem cells—non-specific cells with the potential to turn into specialized cells—to repair tissue and activated growth factors to heal damaged areas.
Another study, published in the Clinical Journal of Sport Medicine, followed 22 people with early knee osteoarthritis who received platelet rich plasma injections and experienced similar results. Patients’ pain levels dropped and their mobility increased at 6 months and again at 1 year.
Another injury shown to improve through PRP is degenerative tendinosis in the Achilles tendon. A study presented at the Radiological Society of North America detailed the success of 80 athletes treated with platelet rich plasma therapy. Tendinosis is a condition resulting from small tears that develop in the tendon but don’t heal properly.
50 of the athletes were experiencing pain in the Achilles tendon while 30 reported tendinosis in the patellar tendon, a structure that joins the shin bone to the kneecap. Study participants received 3 injections and were followed for 1 year after treatment.
Platelet rich plasma treatments reduced pain by 80% in the group with Achilles tendinosis and by 75% in the group with painful patellar tendons. Both groups also reported increased mobility: 53% for the Achilles group and 50% for the patellar group.
Evidence is also mounting for platelet rich plasma therapy’s use in helping people suffering from tennis elbow. This is a pain condition that is triggered by twisting or grasping movements that affects the elbow, forearm, and back of the hand.
Research presented at an American Association of Orthopeadic Surgeons meeting showed pain levels for people with tennis elbow who received PRP treatments dropped by 71% after 24 weeks, compared to a 56% drop in the control group.
Patients selected for the study were those who tried conventional therapies without benefit.
Evidence also shows that athletes or others with cartilage tears benefit from platelet rich plasma therapy. A study presented at an American Orthopaedic Society for Sports Medicine meeting showed that patients treated with platelet rich plasma therapy for chronic knee pain and swelling experienced lower pain levels and improved functioning.
Is PRP an established therapy?
PRP treatment is still an emerging therapy, and clinical studies continue to evaluate the conditions for which it’s most beneficial. Many studies show great benefits, however insurance still does not cover the therapy because it’s considered experimental. Insurance companies’ stances could change soon, however, since accumulating medical evidence in support of platelet rich plasma therapy has spurred medical organizations to release treatment recommendations.
In December 2013, the Journal of the American Academy of Orthopaedic Surgeons released the first paper outlining treatment protocols. Authors said the growing research illustrated platelet rich plasma therapy’s potential to treat conditions such as ankle arthritis and tennis elbow, and endorsed its use. Study authors noted:
“We’re hopeful that our findings can serve as a roadmap on how and when PRP is appropriate in orthopaedic care. Now that we have a better understanding of when this therapy is effective, we can tailor it to other applications. For example, if we know evidence supports PRP use for arthritic ankles and knees, it makes sense to start looking at it for osteoarthritis of the hip.”
The paper’s authors said that the recommendations would hopefully encourage insurance companies to pay for the therapy and guide research to uncover more uses. Wellington Hsu, MD, the lead author on the paper explained:
“Insurers have not covered PRP because of the lack of science. Patients currently pay out of pocket, sometimes thousands of dollars, to get PRP. With evidence-based recommendations, insurance companies hopefully will consider coverage for this therapy.”
What do you think about platelet rich plasma therapy? If you’re interested in learning more about how PRP for plantar fasciitis can help you, contact one of our pain doctors today to talk about your treatment options. (Not in Arizona? Find a pain doctor near you at PainDoctor.com.)