In this video, we are going to talk about PRP, or platelet-rich plasma – what it is, why it might work, and what injuries PRP might be especially useful for – especially plantar fasciitis.
Please understand, in this video, I am not giving you medical advice. This is meant for general information and educational purposes only.
What is platelet-rich plasma?
PRP, also known as platelet-rich plasma, is a concentration of platelets that comes from your whole blood. It is centrifuged to obtain a ready-to-use product.
PRP works by releasing cytokines and growth factors, like platelet derived growth factor, platelet derived endothelial growth factor, transforming growth factor β1, insulin-like growth factor 1, fibroblast growth factor 2, and vascular endothelial growth factor A.
These growth factors enhance healing by stimulating cell proliferation, migration, and differentiation. They also modulate the immune system, inflammation, and angiogenesis, or the development of new blood vessels in the damaged tissue.
Biologic mediators in PRP and how they help healing
Those growth factors are essential for the three phases of healing of injured tendons and ligaments: inflammation, proliferation, and remodeling. In theory, PRP allows for the patient’s own blood to provide a high concentration of growth factors to promote healing in sites that have limited healing capacity due to blood supply. PRP can create a matrix that serves as scaffold for sustained release of growth factors that help bring in healing cells and new blood vessels that help deliver nutrients to improve healing.
Now before we can discuss platelet-rich plasma as a treatment for plantar fasciitis, we need to understand what this injury actually is.
Plantar fasciitis is a common cause of heel pain in athletes and non-athletes alike. It often presents as pain at the base of the heel on the sole of the foot. A patient frequently complains of pain immediately in the morning when he or she first steps out of bed. The patient might also complain of pain when taking the first steps after sitting or lying down for an extended period of time. It is often fairly debilitating to an athlete with the condition, as it causes pain that limits the ability to run. Treatment is typically nonsurgical, including wearing a night splint while sleeping, stretching exercises and physical therapy.
The tissue in plantar fasciitis – the plantar fascia that holds up the arch of your foot – undergoes a small amount of degeneration. It’s not really an inflammation as the term plantar fasciitis suggests. Getting that area of degeneration in the plantar fascia to heal is critical to overcoming the pain with this condition.
Let’s see what recent scientific literature tells us about how effective PRP is for plantar fasciitis.
PRP for plantar fasciitis
A 2017 study found that the treatment of plantar fasciitis with steroid injection or PRP injection was equally effective for patients with plantar fasciitis. On the other hand, a 2020 study found that PRP may lead to a greater improvement in pain and functional outcome over cortisone injections.
Another 2018 study found that leukocyte-rich PRP was effective for plantar fasciitis.
Finally, a 2021 systematic review and meta-analysis in the American Journal of Sports Medicine showed that while PRP and cortisone shots did equally well in the first couple of months, PRP is superior to steroid injections for pain control at 3 months and lasts up to 1 year for plantar fasciitis.
Caution with the research
There are many different methods of preparation, and different final products: PRP, leukocyte-rich PRP, platelet-rich fibrin, platelet gel, and more. All these platelet products have varying concentrations of blood cells, plasma, or fibrinogen. Therefore, they have different concentrations of growth factors and bioactive molecules, meaning they could have different efficacy for plantar fasciitis.
The exact composition of PRP is not reported in many of the available studies. There are differences between leukocyte-rich and leukocyte-poor PRP and much more. Plus, humans have different numbers of platelets in our blood, so studies comparing PRP will lead different results.
Plus, other than the leukocyte content, research studies differ in terms of volume of blood harvested, use of anticoagulant, number and speed of centrifugations, the final volume of PRP obtained, the overall number of platelets, their integrity and activation method, and more. All of these factors that could influence the properties of the final PRP product and how well it helps patients with plantar fasciitis.
Is PRP covered by insurance?
Most insurance companies still consider PRP experimental and will not cover these treatments. And again, I’m not giving you medical advice. This information about platelet-rich plasma is intended for informational and educational purposes only.
Based on these studies, it does appear that PRP is a reasonable treatment option for long-term relief of plantar fasciitis, especially as it compares to cortisone shots. For someone struggling to recover, especially if night splints, stretching, and physical therapy aren’t helping, it might be worthwhile to talk to your doctor about platelet-rich plasma for plantar fasciitis.
Links to studies in the comments
If you would like to read the studies I mentioned in the video, here are links to them:
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I’m Dr. David Geier. Thank you for watching, and I look forward to helping you feel and perform Better Than Ever.