Platelet-Rich Plasma Versus Corticosteroids in the Treatment of Plantar Fasciitis: A Systematic Review and Meta-analysis.
Ankai Zuo, Chengfei Gao, Qiufeng Jia and 4 others
PMID 39778212WHAT IT FOUND
In plantar fasciitis, PRP injections gave better pain relief and foot function at 3 to 6 months than corticosteroid injections, often with local anesthetics.
They did not help more at 1 month or 1 year for pain, and did not reduce fascia thickness more.
Key findings
01PRP injections, sometimes activated with calcium gluconate, were associated with lower pain scores than corticosteroid injections, often combined with local anesthetics, at 3 and 6 months, but not at 1 month or 1 year.
02PRP injections, sometimes activated with calcium gluconate, were associated with higher AOFAS function scores than corticosteroid injections, often combined with local anesthetics, at 3, 6, and 1 year, but not at 1 month.
03The pooled analysis reported no difference in plantar fascia thickness between PRP injections and corticosteroid injections, often combined with local anesthetics, at 1 to 1.5, 3, or 6 months.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The number of participants analyzed differed by outcome. Pain used 756 PRP and 756 corticosteroid participants, function used 339 PRP and 337 corticosteroid participants, and fascia thickness used 202 PRP and 201 corticosteroid participants, although 1,653 participants were included. The pooled pain and function results had high I2 values. The individual trials varied widely. Only 9 of the 24 studies reported blinding of outcome assessors, and the authors noted blinding was a weakness in some included studies. Allocation concealment was appropriately implemented in only 16 of the included studies. PRP preparation varied across trials, including volume, activator use, and platelet concentration, which was almost never reported. Corticosteroid type and brand varied across trials. The AOFAS score was used despite the authors noting a high ceiling effect. Long-term evidence was limited: only 3 studies reported 12-month pain outcomes, and only 2 studies reported 12-month AOFAS outcomes.
Declared interests
Funding came from the Natural Science Foundation of Shandong Province (No. ZR2023MH242). The authors reported no conflicts of interest.
The easy way to misread this
Do not conclude that PRP is the better injection for plantar fasciitis in all time periods or that it heals the fascia more. The trials showed no pain advantage at 1 month or 1 year, no difference in fascia thickness, and used variable PRP preparations with limited blinding.