A PROSPECTIVE STUDY COMPARING THE EFFICACY OF LOCAL INJECTION OF P LATELET -RICH PLASMA VS METHYL PREDNISOLONE IN PLANTAR FASCIITIS

Abstract

Plantar fasciitis is among the most common musculo-skeletal problems in Orthopaedic practice. Any heel pain due to persisting plantar fasciitis will often distress the patient, so the right intervention at the right time is needed. Plantar fasciitis is also common in the rural population. The aim of the study is to evaluate the outcome and the response rate of autologous plateletrich plasma injection vs corticosteroid (methyl prednisolone) injection in patients with plantar fasciitis. Thus, this study avoids surgical intervention for plantar fasciitis in our rural population of study patients. OBJECTIVES: 1. To compare the efficacy of local injection of platelet-rich plasma and corticosteroid (methyl prednisolone) in patients with chronic plantar fasciitis. 2. To evaluate safety, side effect and complications of two different modalities of treatment. MATERIALS AND METHODS: The study was conducted in the period from August 2018 to September 2020. The study group included one hundred and ten patients of age 18 years and above, with plantar fasciitis persisting for more than three months. The final study was done in one hundred and twenty heels with plantar fasciitis in these one hundred and ten patients after obtaining written consent from them. The patient characteristics like history of heel pain, gender, age, weight, duration of symptoms and types of prior treatment was noted. Ten patients dropped out during the study. Of the 110 patients, 55 received PRP injection and 55 received CS - 2ml (40 mg) methyl prednisolone with 2 ml of sterile water for injections. With each follow up, clinical, subjective, radiological and functional outcomes were assessed at 1st month, 3rd month and xxi 6th month by using Visual Analog Scale (VAS), Foot and Ankle outcome Instrument core scale (FAI) and Roles Maudsley scores (RMS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot scale and Ultrasonogram of plantar fascia thickness. DISCUSSION: 110 patients were included in this study and 120 painful heels were screened and evaluated in this study. There were ten drop outs in this study. Of the patients‘ studies, 59 were females and 41 were males. Most of the patients were in the normal weight range of 18.5 to 24.9, mean BMI being 23.6. The mean age group of patients in PRP and CSIs groups was 46.74 ± 12.45 years and 48.5 ± 10.39 years respectively. The mean VAS value before injection, at 1st month, 3rd month and 6th month in PRP group were 7.32 ± 0.587, 5.78 ± 0.679, 4.52 ± 0.505, 3.5 ± 0.614 respectively. The mean VAS value before injection, at 1st month, 3rd month and 6th month in CS group were 7.24 ± 0.555, 6.46 ± 0.813, 5.64 ± 0.693, 4.44 ± 0.501 respectively. Hence, significant improvement was observed in PRP injection group. Subjective ratings were assessed using Roles Maudsley Score, at the 1st month follow up, Roles Maudsley Score was excellent, good, fair and poor in 10, 16, 20, 4 patients respectively in PRP group and was excellent, good, fair and poor in 17, 17, 10 and 6 patients respectively in the corticosteroid group. At 3rd month follow up, Roles Maudsley Score was excellent, good, fair and poor in 17, 21, 11, 1 patients respectively in the PRP group and was excellent, good, fair and poor in 0, 11, 25 and 14 patients respectively in the corticosteroid group. At the 6th month follow up, Roles Maudsley Score was excellent, good, fair and poor in 32, 13, 0, 5 patients respectively in the PRP group and was excellent, good, fair and poor in 6, 2, 9 and 33 patients respectively in the corticosteroid group. The mean AOFAS of the subjects in the PRP injections group (pre-injection, 1st month, 3rd month & 6th month) was 59.58, 70.74, 82.20, 92.04 respectively and the mean AOFAS of the subjects in the CSIs group (pre-injection, 1st month, 3rd month & 6th month) was 56.62, 64.08, 71.22, 76.04 respectively. Mean FAI score of the patients in the PRP injections group (pre-injection, 1st month, 3rd month & 6th month) was 100.58, 81.54, 61.86, 41.10 respectively and the mean FAI score of the subjects in the CSIs group (pre-injection, 1st xxii month, 3rd month & 6th month) was 100.14, 80.84, 73.40, 68.00 respectively. Mean thickness of plantar fascia of the subjects who received PRP injections (pre-injection, 1st month, 3rd month & 6th month) were 6.02, 4.96, 4.02, 3.24 respectively and the mean plantar fascia thickness of the subjects in CSIs group (pre-injection, 1st month, 3rd month & 6th month) were 6.30, 5.28, 5.12, 5.06 respectively. On comparing the results in both the groups as above, improvement was observed in the PRP group. Two patients had post-operative complications (superficial infection) in PRP injection group, while ten patients had post-operative complications (five patients developed superficial infections, three patients developed skin depigmentation, and two patients had atrophy of fat pad) in CSI group. Infection subsided for patients in both the groups on subsequent follow up. CONCLUSION: Our study findings prove that PRP is the good method of management in patients of chronic plantar fasciitis, presenting with some discomfort following activity, with more than three month symptom duration, with VAS score of more than 6 and plantar fascia thickness 5mm and failed conservative management. This is evidenced by comparison of AOFAS, FAI score and Ultrasonogram of plantar fascia thickness before and after the procedure. This study has shown better results with PRP injection compared with local steroid infiltration. This is the largest case series studied compared to previously available studies in the literature. PRP injection may be thus used as a superior alternative to the existing treatments for chronic heel pain.