Plantar Fasciitis – PRP Therapy in Los Angeles
There are many common pains we experience within the foot and lower extremities. Patients are lucky that their heel pain goes away, but what are they to do when the pain comes back or heel and arch pain become chronic in nature? These chronic pain occurrences have a tendency to be more common in females as well as athletes and runners. The most common cause of a patient’s heel pain is plantar fasciitis, which is commonly associated with concomitant heel spur syndrome. This entity usually becomes chronic in nature if left untreated.
Plantar fasciitis is a musculoskeletal disorder affecting the plantar fascia, the thick band or ligament that runs across the bottom of the foot that connects the heel to the toes. The fascia first becomes irritated and then inflamed which results in heel pain.
Symptoms of Plantar Fasciitis
Patients with plantar fasciitis issues, often describe the pain as worse when they wake up and start walking around in the morning or after sitting for long periods of time. Plantar fasciitis generally causes a stabbing pain in the bottom of the feet, near the heel. As time wears on, and the patient has been walking for a few minutes, the pain decreases and feels less tender. For some patients, they realize their pain subsides, but then after a long period of resting or trying to stand again, the fascia will hurt as it did when awakening at the beginning of the day. This symptom is called post static dyskinesia or pain after periods of rest, which is the most consistent symptom in most plantar fasciitis sufferers.
Causes of Plantar Fasciitis
Plantar fasciitis is generally the result of faulty biomechanics in a patient that unconsciously forces the body to place too much stress on the heel bone and connective ligaments. Under normal circumstances, a patient’s plantar fascia acts as the shock-absorbing ligament, that supports the arch of the foot. Some of the causes for the pain associated with Plantar Fasciitis are as follows:
- Walking gait abnormalities
- Equinus or tight calve muscles/ Tight Hamstrings
- Repetitive stretching
- Constant tearing of the plantar fascia due to untreated plantar fasciitis (called Plantar fasciosis)
- Wearing non-supportive footwear
- Pronation- a faulty type of gait pattern that causes chronic wear and tear of the lower extremity supporting structures of the foot and ankle.
- Undiagnosed Limb Length Discrepancies (both functional and structural)
- Injury during physical activity on hard surfaces
Plantar Fasciitis PRP (Platelet Rich Plasma) Therapy
The first step in the right direction is to have your foot analyzed by a board certified podiatrist and foot surgeon. Our foot and ankle surgeon makes it clear that every patient should undergo a comprehensive physical examination and review of medical history to determine the cause of your foot pain. To further assist in diagnosis, Dr. Kamran Jamshidinia may order xrays, ultrasound imaging or magnetic resonance imaging (MRI) to make sure your pain is not caused by another foot issue, such as stress fracture or associated nerve entrapment syndromes of the heel which can mimic plantar fasciitis- a condition called baxters nerve entrapment.
After diagnosis, there are a number of advanced therapy solutions that serve for chronic plantar fasciitis and foot pain. The American College of Foot and Ankle Surgeons report that approximately 2 million patients suffer from moderate-to-severe heel pain per year. While some conservative strategies are effective for at-home pain relief, none can surpass the efficiency of the non-surgical approach of platelet rich plasma therapy.
Platelet rich plasma therapy is an advanced treament technique for chronic plantar fasciitis and other foot and ankle abnormalities. Many of our patients in the past with chronic plantar fasciitis have not experienced relief from conservative stretches or custom orthotics due to the limited blood supply that reaches the bottom of the foot – a necessity for healing. In the end, the goal of PRP therapy is to increase healthy blood supply and increase growth factors presence at high concentration to initiate healing of the plantar fascia.
PRP therapy can be performed with or without ultrasound guidance at our outpatient facility. First, blood is drawn from the patient into a closed system. A closed system means the blood is drawn into an advanced syringe much like the way blood is drawn from a patients arm for blood tests. This highly advanced syringe is put directly into a specialized centrifuge designed specifically for PRP concentration and the blood within 5 minutes will be purified in our centrifugal system to separate the platelets from the other blood cells. Once the PRP cells are separated, they are then injected into the damaged scar tissue in the plantar fascia. The injection facilitates the process of regeneration and remodels the damaged structures of the bottom of the foot, and pain and swelling of the inflamed tissue subsides. What is unique about PRP is that it is utilizing your own bodies ability to heal itself without surgery. Healing cells at times can not get to damaged tissues of the lower extremity due to scar tissue and limited blood supply. When structures are completely torn or require surgical treatment to repair, those repairs will need to be performed first along with PRP therapy. Dr Jamshidinia and his associates will be able to evaluate your foot and ankle for PRP vs PRP plus Surgery based on advanced imaging modalities that can and will be utilized after initial consultation.
What does the medical literature say about PRP Therapy for Plantar Fasciitis:
Foot Ankle Int. 2014 Apr;35(4):313-8. doi: 10.1177/1071100713519778. Epub 2014 Jan 13.
Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis.
Chronic plantar fasciitis is a common orthopedic condition that can prove difficult to successfully treat. In this study, autologous platelet-rich plasma (PRP), a concentrated bioactive blood component rich in cytokines and growth factors, was compared to traditional cortisone injection in the treatment of chronic cases of plantar fasciitis resistant to traditional nonoperative management.
Forty patients (23 females and 17 males) with unilateral chronic plantar fasciitis that did not respond to a minimum of 4 months of standardized traditional nonoperative treatment modalities were prospectively randomized and treated with either a single ultrasound guided injection of 3 cc PRP or 40 mg DepoMedrol cortisone. American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scoring was completed for all patients immediately prior to PRP or cortisone injection (pretreatment = time 0) and at 3, 6, 12, and 24 months following injection treatment. Baseline pretreatment radiographs and MRI studies were obtained in all cases to confirm the diagnosis of plantar fasciitis.
The cortisone group had a pretreatment average AOFAS score of 52, which initially improved to 81 at 3 months posttreatment but decreased to 74 at 6 months, then dropped to near baseline levels of 58 at 12 months, and continued to decline to a final score of 56 at 24 months. In contrast, the PRP group started with an average pretreatment AOFAS score of 37, which increased to 95 at 3 months, remained elevated at 94 at 6 and 12 months, and had a final score of 92 at 24 months.
PRP was more effective and durable than cortisone injection for the treatment of chronic recalcitrant cases of plantar fasciitis.
LEVEL OF EVIDENCE:
Level I, prospective randomized comparative series.
Schedule PRP Therapy for Plantar Fasciitis with Dr. Jamshidinia
As you can see, platelet rich plasma therapy is advised treatment for patients with chronic issues of plantar fascia. Typically many patients will have undergone a number of other conservative treatment methods including cortisone injections before resorting to PRP therapy. Unfortunately many of these conservative treatments fail as they serve only to mask the symptoms of Plantar fasciitis allowing the condition to get worse overtime. If you have tried everything you could to accelerate pain relief then now may be the time to contact our PRP therapy specialist. Contact our office and schedule a consultation to learn about your options to treat plantar fasciitis. Call (310) 247-9255 or (310)24-7 WALK.