Therapeutic Efficacy of Platelet-Rich Plasma Injection Compared to Corticosteroid Injection in Plantar Fasciitis

Abstract

Objective: This study aimed to conduct a comprehensive comparative evaluation of the therapeutic efficacy of platelet-rich plasma injections versus corticosteroid injections in the management of plantar fasciitis.

Methodology: A meticulously designed prospective, randomized controlled trial was carried out on 90 patients diagnosed with chronic plantar fasciitis, all of whom had failed to respond to conservative interventions for a minimum duration of three months. The participants were randomly allocated into two treatment groups: Group A received corticosteroid injections (40 mg methylprednisolone combined with 2 mL of lidocaine), while Group B underwent PRP therapy, where autologous platelet-rich plasma was prepared through a standardized double-centrifugation process. The efficacy of the treatments was rigorously assessed using multiple objective and subjective outcome measures, including the Visual Analog Scale for pain intensity, the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale for functional assessment, the Foot and Ankle Instrument Core Scale for overall foot health evaluation, and ultrasound-based measurements of plantar fascia thickness. Patients were monitored and systematically evaluated at 1-, 3-, and 6-months post-injection to determine both the immediate and sustained effects of each intervention.

Results: The results revealed a distinct temporal contrast between the two treatment modalities. Corticosteroid injections demonstrated a more pronounced and immediate analgesic effect, yielding significantly lower VAS scores at 1 month (p = 0.005) and 3 months (p = 0.003) compared to PRP. However, by the six-month follow-up, the pain-relief outcomes between the two groups converged, with no statistically significant difference in VAS scores (p = 0.507). Functional assessments exhibited a similar trend; corticosteroids facilitated a more rapid improvement in mobility and symptom relief, while PRP therapy, though slower in onset, provided a progressive and sustained enhancement in foot function. By six months, a significantly higher proportion of patients in the PRP group achieved “excellent” functional outcomes. Ultrasound-based structural analysis further corroborated these findings—while corticosteroids induced an immediate reduction in plantar fascia thickness, PRP therapy exhibited a more consistent and sustained decrease over time (p = 0.015 at 1 month, p = 0.020 at 3 months). This suggested that PRP not only alleviated symptoms but also played a pivotal role in tissue regeneration and long-term healing.

Conclusion: The study concluded that corticosteroid injections served as an effective short-term intervention for providing rapid symptomatic relief in plantar fasciitis. However, PRP therapy emerged as a superior long-term therapeutic alternative, demonstrating its regenerative potential in promoting sustained pain reduction, functional recovery, and structural healing of the plantar fascia. Given the risks associated with repeated corticosteroid use, including potential tendon degradation and fat pad atrophy, PRP may represent a more viable option for patients seeking durable recovery without compromising tissue integrity. Future research should be directed toward optimizing PRP preparation protocols, refining injection techniques, and further elucidating the patient subgroups that would derive maximal benefit from this regenerative treatment.