Platelet-rich plasma injections for chronic plantar fasciopathy: a systematic review.

INTRODUCTION: There is an increasing interest in platelet-rich plasma (PRP) injection as a treatment for chronic plantar fasciopathy (PF). We wished to evaluate the evidence for the use of PRP in PF/fasciitis. SOURCES OF DATA: We performed a systematic review on the effects of PRP in PF. In June 2014, we searched Medline, Cochrane, CINAHL and Embase databases using various combinations of the commercial names of each PRP preparation and 'plantar' (with its associated terms). We only included prospectively designed studies in humans. AREAS OF AGREEMENT: Eight articles met the inclusion criteria, three of them were randomized. All studies yielded a significantly greater improvement in symptoms between baseline and last follow-up assessment. None of the papers recorded major complications. AREAS OF CONTROVERSY: Only three randomized studies were identified; none of them had a true controlled group treated with placebo and one of the three studies had a very short (6 week) follow-up. A non-randomized study evaluating PRP versus corticosteroids (CCS) injections, and a randomized controlled trial comparing PRP and dextrose prolotherapy reported no statistical significant differences at 6 months. Most studies did not have a control group and imaging evaluation. GROWING POINTS AND AREAS FOR RESEARCH: Evidence for the use of PRP in PF shows promising results, and this therapy appears safe. However, the number of studies available is limited and randomized placebo-controlled studies are required. Characterizing the details of the intervention and standardizing the outcome scores would help to better document the responses and optimize the treatment.