Platelet Rich Plasma for Plantar Fasciitis – writing about something I know nothing about…

Platelet Rich Plasma for Plantar Fasciitis

I have to be honest and admit that the use of platelet rich plasma (PRP) for plantar fasciitis is something that I have had no more than a superficial interest in. I pretty much scanned the abstracts of the studies and systematic reviews as they are published of it in this thread and the one comparing it to other interventions on Podiatry Arena. I also note comments in social media on it from those whose views I respect. From my superficial understanding, it works, it does not work, it works, it does not work … a lot of the studies that compare it to other treatments do not do the “other” treatment very well (ie wrong dosing), which can easily bias the study to PRP being better. Some of the comments in social media from people who I consider real experts, especially in the context of tendinopathy are that it does not work, yet a lot of people claim it does. Yes, I know that the “plantar fasica” is not a “tendon” and it may or may not be appropriate to translate “tendinopathy” research to “plantar fasciitis” (not that this stops people doing so or not doing so if the research on it matches their pre-conceived biases!).

I do note that the most recent meta-analysis of PRP concludes that it is as effective as other interventions. I do note when I glance at most of the studies that do get included in the systematic reviews and meta-analyses that there does appear to be some methodological issue with almost all of them, so how much weight should be given to them?

Anyway, as you can see, I really do not know much about PRP for plantar fasciitis except for that superficial understanding of the evidence and listening to those whose views I normally respect. However, my interest in PRP picked up a week ago when at the AAPSM meeting in San Francisco in which there was a presentation on the topic.

I stand to be corrected and have not verified this by searching the literature, but he said two things in the presentation that I think I interpreted correctly that really got me interested:

1) Local anaesthetic deactivates the PRP. What this means is that if a lot of local was infiltrated in the area vs just a small superficial amount prior to the PRP injection then this may affect the clinical effectiveness of the PRP. Of more importance, if a lot of local was used in a study of PRP, then that would bias the study in the direction of the PRP not being effective. That study is unlikely to be excluded from a meta-analysis or systematic review if all the other methodological issues are sound (ie sample size, blinding etc).

2) The effectiveness of PRP in tendons (he did not mention this in the context of the plantar fascia) might depend on the leucocyte concentration in the PRP. I have not checked the literature on this, but I think he said the PRP works in tendons if the leucocyte concentration is high and does not work in tendons if the leucocyte concentration is low. If this is correct, then it is easy to see how a study could be biased against it working if the leukocyte concentration is low. Those low leucocyte concentration studies will be included the in the meta-analyses and biases them in the direction of PRP not being effective for tendons.

Again, I no expert (or even have a little knowledge) in this and I only superficially aware of the literature in this, but even I can see the issues here. The use of small vs high amounts of local before injecting the PRP and the effectiveness of high vs low concentration of leukocytes in the PRP are issues that need to be resolved and potentially could have huge impacts on the results of individual studies, systematic reviews and meta-analyses; and, more importantly, policy recommendations and clinical guidelines that grow out of that. I see this as a serious problem.

It may well be that if studies are repeated on the local anaesthetic dose and the leucocyte concentration that it does not affect the outcome and then will not bias the systematic reviews and meta-analyses. It is, however, an issue that should be resolved.

Does PRP work for plantar fasciitis? My conclusion is that we do not yet know.

Does this sound familiar? Its the same issues I wrote about on foot orthotic dosing … or am I just being biased or using the logical fallacy of ‘special pleading’?

Please sign up for my newsletter when a new content is posted:





Advertisement:

Bestseller No. 1
Podiatry Student Handbook: (Second Edition)
  • Shi, Eric (Author)
  • English (Publication Language)
SaleBestseller No. 2
Coding Companion for Podiatry 2021
  • OPTUM360 (Author)
  • English (Publication Language)
Bestseller No. 3
Podiatry Axial/Sesamoid Weight Bearing Sponge - 13" x 8" x 4" Closed Cell
  • Closed Cell - 13" x 8" x 4"
  • Closed Cell Sponges are made from a lightweight, radiolucent, non-porous foam - entirely fluid resistant, easy to clean and extremely durable! Non-coated, premium charcoal grey color. 100% radiolucent artifact free imaging.
SaleBestseller No. 4
Bestseller No. 5
Funny Foot Whisperer Podiatry for Podiatrist T-Shirt
  • Funny Foot Whisperer quote for Podiatrist, Orthopedist and Chiropodist who loves to heal foot disorders. A Doctor of Podiatric Medicine loves funny podiatry quotes for birthday, christmas or father's day.
  • Medical students gift idea for future foot whisperer who love to care feet. A Funny gift for every passionate podiatrist and Chiropodist. A funny food doctor quote for men and women. Every legendary Podiatrist loves Podiatry Humor.
Bestseller No. 7
Duty Stainless Veterinary Clipper Toe Nipper pet Heavy Nail Podiatry Instrument Cutter Cutting Forceps toenail nippers Clippers Pets ingrown Professional Razor Supplies Cutters Thick toenails Curved
  • ► HEAVY DUTY TOE NAIL CLIPPERS: SurgicalOnline's 5.5" Double Barrel Spring heavy-duty toe nail clippers are designed for thick and tough fingernails and toenails. The podiatrist toenail clippers are ideal for both professionals and home use - for Men, Women, Seniors and even pets. Effortlessly and safely cut thick toenails, ingrown nails and hangnails with the razor sharp edge and double barrel spring clippers.
  • ► PREMIUM QUALITY STAINLESS STEEL: Forged from O.R. Grade Stainless Steel, the Podiatrist Toenail Clippers for the best product life and performance. The curved razor sharp edge ensures a precise smooth cut through thick nails with ease. Corrosion resistant, tarnish free with a locking safety clasp for ultimate portability and convenience. High quality curved blade design stays sharper longer for amazing results over many years!
SaleBestseller No. 8
Pocket Foot and Ankle Medicine and Surgery (Pocket Notebook Series)
  • English (Publication Language)
  • 400 Pages - 07/18/2018 (Publication Date) - LWW (Publisher)
Bestseller No. 9
Professional Double Ended Nail Curette 1.5/2.5mm Dermal Ingrown Toenail Cleaner Scoop Chiropody Podiatry Tools
  • Manufactured from High Quality Medical Grade Stainless Steel
  • Nail Cleaning and Care Instruments
Bestseller No. 10
Podiatry
  • Medical Details
  • English (Publication Language)

I get commissions for purchases made through links on this website. As an Amazon Associate I earn from qualifying purchases