“Are you suffering from chronic plantarfasciitis that just will not settle”?
“Have you seen a physiotherapist and been prescribed a set of rehabilitation exercises with no effect”?
“Have you seen a podiatrist and been prescribed a pair of orthotics or a heel raise, but continue to experience plantarfascia pain”?
“Have you tried shockwave therapy but are still suffering with heal pain”?
“Have you had a steroid injection but unfortunately the pain has returned”?
Plantar fasciitis can be notoriously difficult to resolve. There are now many different treatment options available to treat this condition and so choosing the right treatment can be challenging. At Complete Injections we offer two safe evidence based injection options for treating Plantar fasciitis.
One option is a corticosteroid injection. If you wish to understand more about this treatment option please follow this link.
In recent years people suffering from plantar fasciitis have started to look for effective alternatives to the traditional corticosteroid injection. PRP has been shown to be a very safe option for treating this condition. Research has also revealed PRP to have less side effects and has fewer reactions with other medication. This blog describes the role of PRP in the treatment of plantar fasciitis.
What is plantarfasciitis and why is it so resistant to treatment?
The plantarfascia is a thick, strong band of connective tissue located under the foot. It originates from under the heel and terminates at the big toe. The plantar fascia is designed as an energy-saving structure, storing and releasing energy during walking and running.
The plantarfascia becomes accustomed to the demands placed on it. If it is suddenly exposed to an increased demand, such as starting a new sport, putting on weight or significantly increasing your step count, it can become irritated and inflamed. The condition of an irritated and inflamed plantarfascia is known as plantarfasciitis. Over prolonged or repeated periods of irritation, the plantarfascia can become inherently weakened. Its internal structure becomes disorganised, resulting in a thickened, weakened, and painful plantarfascia. A chronically painful plantarfascia is known as a plantarfascitis.
Heal pain, including both plantarfasciitis can be challenging to treat. Unfortunately, by the time plantarfascia pain becomes painful, the structural damage has often already occurred. Early signs of a plantarfascia condition are often low in irritability and quick to settle, which can lead to a continuation of activities that aggravate the condition, such as increased activity levels. Furthermore, poor footwear and weak or tight calf muscles can also exacerbate plantarfascia pain. Because of its nature, patients typically do not seek help until their condition has become chronic, defined as pain that has been present for over 3 months. This makes the treatment of plantarfascia pain particularly challenging.
Conservative treatments for plantarfasciitis have been shown to successfully treat up to 90% of cases and typically include the following modalities (Hurley et al., 2020):
- A biomechanical assessment of the way you move, walk, or run.
Supportive footwear - Orthotic insoles – these can be provided by a podiatrist following a biomechanical assessment
- A strengthening and stretching program specifically designed to address your contributing factors
- Soft tissue massage
- Acupuncture If pain and symptoms persist despite the use of conservative measures, shockwave therapy can also be used.
- Shockwave therapy – Shockwave is a medical device that delivers a series of powerful soundwaves into the plantarfascia. Research has shown that shockwave therapy can stimulate a healing response within the plantarfascia.
If conservative treatments including shockwave are not effective then an ultrasound guided injection should be considered.
There are two injection options available for treating plantar fascia pain.
What are the two most effective injection techniques for plantar fasciitis?
The most effective two injection techniques for plantar fasciitis are:
1/ Steroid injection. A steroid injection is a powerful anti-inflammatory that can quickly and effectively reduce pain and inflammation. It is used to treat the inflammatory component of plantar fasciitis.
2/ PRP injection. A PRP injection is used to reinitiate the healing process in chronic conditions such as plantar fasciopathy. This is the focus of this blog.
What is PRP and how does it work?
PRP injections are highly effective at treating chronic conditions such as plantar fasciitis. PRP injections harness your own body’s healing potential to help reduce pain and increase function. Platelets, found within blood, are crucial components of the healing process and are responsible for reducing pain and promoting soft tissue and bone healing. By introducing a concentrated dose of platelets into damaged or poorly healed tissue, such as in plantar fasciopathy, it kickstarts a chemical response that drives a healing response.
How are PRP injections completed?
In order for a PRP injection to be administered, blood must be extracted from your arm. Similar to giving blood, a tourniquet is placed around your upper arm and a small needle is introduced into a vein. The extracted blood sample is placed in a centrifuge machine and spun at high speeds, separating the red blood cells from the platelets (found in the plasma). Once the target area has been anaesthetised, the platelets (and plasma) are deposited, under ultrasound guidance, directly into the damaged tissue. This procedure is known as platelet-rich plasma therapy (PRP) and is used to treat chronic conditions such as plantar fasciopathy.
Why should you choose PRP injections over other injection options for treating your plantarfascia pain?
Many current systematic reviews have shown that PRP injections for treating plantarfasciitis are more effective than steroid injections, with reported benefits lasting up to one year. This allows patients to engage in a rehabilitation program to address the underlying causes of their pain. Studies such as Xing Fei et al., (2021), Alkhatib et al., (2020), Hohmann et al., (2020), and Hurley et al., (2020), have shown the effectiveness of PRP injections in treating plantarfasciitis.
Is PRP safe for me and my plantarfascia?
PRP injections are a safe and effective treatment option for chronic plantarfasciitis. They use the patient’s own platelets to promote healing and reduce pain, with minimal side effects. Systematic reviews have found that PRP injections for treating plantarfasciitis yield better outcomes than steroid injections, with benefits lasting for up to one year (Xing Fei et al., (2021); Alkhatib et al., (2020); Hohmann et al., (2020); Hurley et al., (2020). This gives patients ample time to commit to a rehabilitation program to address the underlying causes of their pain.
Are PRP injections painful?
PRP injections are an effective treatment option for chronic conditions such as plantarfasciitis. These injections use a patient’s own platelets, which are found within the blood and play a crucial role in the healing process, to reduce pain and promote tissue, blood vessel, and bone healing. PRP injections are considered to be safer than steroid injections, as they do not contain any medication and have little to no side effects. However, patients may experience a short period of increased pain following a PRP injection as the initial phase of the healing process is inflammation. To ensure an effective healing process, it is recommended that patients avoid using ice or taking anti-inflammatory medication for a short period after a PRP injection.
How many PRP injections do I need to have?
A course of up to three PRP injections is typically required to treat chronic conditions such as plantarfascitis. PRP injections for treating plantarfascitis should be spaced roughly three weeks apart. The healing response stimulated by a course of PRP continues to work long after the course of PRP injections are completed, with many patients experiencing continued benefits over the following few months.
How do I get the best out of a PRP injection?
In order to get the most out of a PRP injection for plantarfascial pain, there are several steps you can take. Firstly, it is important to allow a short period of rest immediately after the injection, typically 7-10 days. Secondly, it is essential to avoid using anti-inflammatory medication or ice during the first 72 hours following the injection in order to allow the inflammatory process to take place. Instead, we recommend using paracetamol to manage any symptoms. Additionally, PRP injections should not be considered as a standalone treatment. It is important to also see a physiotherapist and, in some cases, a podiatrist, to address the underlying causes of pain. This will ensure the most effective healing process and long-term benefits.
What should I do if my pain continues, even after PRP injections?
In rare cases, when conservative management including shockwave therapy and injection therapy fail to alleviate your pain and symptoms, referral to an orthopaedic consultant may be necessary for a surgical opinion. Surgery is very rarely required for plantarfasciitis. Your treating clinician will be able to discuss this with you and guide you towards the right consultant.. Complete Injections works closely with some of the country’s top foot and ankle consultants and can quickly and effectively refer you to them if needed.
To make an appointment or to talk to one of our clinical experts contact Complete 020 7482 3875 or email injections@complete-physio.co.uk.
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