Use of platelet rich plasma to treat plantar fasciitis: design of a multi centre randomized controlled trial

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Abstract

Background

If conservative treatment for chronic plantar fasciitis fails, often a corticosteroid injection is given. Corticosteroid injection gives temporarily pain reduction, but no healing. Blood platelets initiate the natural healing rate. GPS ^®gives an eightfold concentrate platelets of patients own blood. Injection of these platelets in the attachment of the fascia to the os calcis might induce a healing rate.

Methods and design

A randomized controlled multi centre trial will be performed. The study population consists of 120 patients of 18 years and older. Patients with chronic plantar fasciitis will be allocated randomly to have a steroid injection or an autologous platelet concentrate injections. Data will be collected before the procedure, 4,8,12,26 weeks and 1 year after the procedure.

The main outcome measures of this study are pain and function measured with questionnaires.

Conclusion

Recent literature show positive effects for the treatment of tendinosis with autologous platelet injections. The forthcoming trial will compare treatment for chronic plantar fasciitis with a steroid injection versus an autologous platelet injection. Our results will be published as soon as they become available.

Trial Registration

Trial registration number: http://www.clinicaltrials.gov NCT00758641.

Related collections

Most cited references 26

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Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes.

Harold Kitaoka, Ian J. Alexander, Robert Adelaar … (1994)

Four rating systems were developed by the American Orthopaedic Foot and Ankle Society to provide a standard method of reporting clinical status of the ankle and foot. The systems incorporate both subjective and objective factors into numerical scales to describe function, alignment, and pain.

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A retrospective case-control analysis of 2002 running injuries.

J E Taunton (2002)

To provide an extensive and up to date database for specific running related injuries, across the sexes, as seen at a primary care sports medicine facility, and to assess the relative risk for individual injuries based on investigation of selected risk factors. Patient data were recorded by doctors at the Allan McGavin Sports Medicine Centre over a two year period. They included assessment of anthropometric, training, and biomechanical information. A model was constructed (with odds ratios and their 95% confidence intervals) of possible contributing factors using a dependent variable of runners with a specific injury and comparing them with a control group of runners who experienced a different injury. Variables included in the model were: height, weight, body mass index, age, activity history, weekly activity, history of injury, and calibre of runner. Most of the study group were women (54%). Some injuries occurred with a significantly higher frequency in one sex. Being less than 34 years old was reported as a risk factor across the sexes for patellofemoral pain syndrome, and in men for iliotibial band friction syndrome, patellar tendinopathy, and tibial stress syndrome. Being active for less than 8.5 years was positively associated with injury in both sexes for tibial stress syndrome; and women with a body mass index less than 21 kg/m(2) were at a significantly higher risk for tibial stress fractures and spinal injuries. Patellofemoral pain syndrome was the most common injury, followed by iliotibial band friction syndrome, plantar fasciitis, meniscal injuries of the knee, and tibial stress syndrome. Although various risk factors were shown to be positively associated with a risk for, or protection from, specific injuries, future research should include a non-injured control group and a more precise measure of weekly running distance and running experience to validate these results.

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The roles of growth factors in tendon and ligament healing.

Timothy J Molloy, George A. C. Murrell, Yao Wang (2002)

Tendon healing is a complex and highly-regulated process that is initiated, sustained and eventually terminated by a large number and variety of molecules. Growth factors represent one of the most important of the molecular families involved in healing, and a considerable number of studies have been undertaken in an effort to elucidate their many functions. This review covers some of the recent investigations into the roles of five growth factors whose activities have been best characterised during tendon healing: insulin-like growth factor-I (IGF-I), transforming growth factor beta (TGFbeta), vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), and basic fibroblast growth factor (bFGF). All five are markedly up-regulated following tendon injury and are active at multiple stages of the healing process. IGF-I has been shown to be highly expressed during the early inflammatory phase in a number of animal tendon healing models, and appears to aid in the proliferation and migration of fibroblasts and to subsequently increase collagen production. TGFbeta is also active during inflammation, and has a variety of effects including the regulation of cellular migration and proliferation, and fibronectin binding interactions. VEGF is produced at its highest levels only after the inflammatory phase, at which time it is a powerful stimulator of angiogenesis. PDGF is produced shortly after tendon damage and helps to stimulate the production of other growth factors, including IGF-I, and has roles in tissue remodelling. In vitro and in vivo studies have shown that bFGF is both a powerful stimulator of angiogenesis and a regulator of cellular migration and proliferation. This review also covers some of the most recent studies into the use of these molecules as therapeutic agents to increase the efficacy and efficiency of tendon and ligament healing. Studies into the effects of the exogenous application of TGFbeta, IGF-I, PDGF and bFGF into the wound site singly and in combination have shown promise, significantly decreasing a number of parameters used to define the functional deficit of a healing tendon. Application of IGF-I has been shown to increase in the Achilles Functional Index and the breaking energy of injured rat tendon. TGFbeta and PDGF have been shown separately to increase the breaking energy of healing tendon. Finally, application of bFGF has been shown to promote cellular proliferation and collagen synthesis in vivo.

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Author and article information

Journal

Journal ID (nlm-ta): BMC Musculoskelet Disord

Title: BMC Musculoskeletal Disorders

Publisher: BioMed Central

ISSN (Electronic): 1471-2474

Publication date Collection: 2010

Publication date (Electronic): 14 April 2010

Volume: 11

Page: 69

Affiliations

[1 ]Department of Orthopaedics, Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands

[2 ]Department of Orthopaedics, HAGA Ziekenhuis Den Haag, The Netherlands

[3 ]Department of Orthopaedics, Diaconessenhuis Leiden, The Netherlands

[4 ]Department of Orthopaedics, St. Antonius Ziekenhuis Nieuwegein, The Netherlands

[5 ]Department of Orthopaedics, Elisabeth Ziekenhuis Tilburg, The Netherlands

Article

Publisher ID: 1471-2474-11-69

DOI: 10.1186/1471-2474-11-69

PMC ID: 2861637

PubMed ID: 20398269

SO-VID: 19013fc3-59cd-4c59-9dd7-249504e0daec

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Use of platelet rich plasma to treat plantar fasciitis: design of a multi centre randomized controlled trial

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Abstract

Background

Methods and design

Conclusion

Trial Registration

Related collections

Orthopedics

Most cited references 26

Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes.

A retrospective case-control analysis of 2002 running injuries.

The roles of growth factors in tendon and ligament healing.

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