Comparison of plasma rich platellet (PRP), dry needling and corticosteroid effects in the treatment of plantar fasciitis

Plantar fasciitis (PF) is generally defined as an overload of the plantar fascia and is the most common cause of heel pain in adults. It is an inflammatory process resulting from repetitive microtraumas that lead to micro-tears of the plantar fascia. Although PF is generally seen in all ages and genders, it is more common in women with a sedentary life and especially in athletes doing jogging sports. Non-steroidal anti-inflammatory drugs, corticosteroid injections, orthoses and physical therapy modalities can be listed in the treatment of plantar fasciitis. Our aim is to determine the effects of Platelet-rich plasma, which is an easy and inexpensive method in the treatment of plantar fasciitis, on pain and function and to compare it prospectively with steroid injection and dry needling applications, which are frequently used clinically. 75 patients diagnosed with chronic plantar fasciitis were divided into 3 groups. PRP, which was obtained manually by taking blood from the antecubital veins of the patients in Group A (n=25), which is the PRP group, was administered as a single dose. A single dose of 40 mg/2ml methylprednisolone was administered to the patients in Group B (n=25), which is the steroid group. Dry needling method was applied to the patients in Group C, which is the dry needling group. Visual pain scale (VAS), The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score (AOFAS), and Roles and Maudsley Pain Score (RMS) were evaluated separately for each group before treatment, at 3 weeks, 3 months, and 6 months, respectively. Statistical analyzes were made at the end of the study. In the PRP group, the mean VAS score before the treatment is 8.56 that decreased to 5.24 at the 3rd week, to 3.44 at the 3rd month, and to 1.44 at the 6th month (p<0.05). In the PRP group, the mean AOFAS scores 46.08 before the treatment that scores increased to 66.1 at the 3rd week, to 74.8 at the 3rd month and to 87.4 at the 6th month (p<0.05). Again, in the PRP group, the RMS scores 3.48 before the treatment that scores decreased to 2.6 at the 3rd week, to 2,0 at the 3rd month, and to 1.36 at the end of 6th months (p<0.05). In the steroid group, the mean VAS score before treatment and at 6 months decreased from 8.64 to 3.92, the AOFAS score increased from 41.6 to 74.96, and the RMS score decreased from 3.48 to 1.84 (p<0.05). In the dry needling group, the mean VAS score before treatment and at 6 months decreased from 8.64 to 4.60, the AOFAS score increased from 42.9 to 70.28, and the RMS score was decreased from 3.48 to 2.08 (p<0.05). At the end of the 3rd week, it was observed that the VAS and AOFAS scores of the steroid group showed positive changes compared to the PRP and dry needling groups (p<0.05). At the end of the 6th month, it was noted that the change in VAS, RMS and AOFAS scores of the PRP group was significantly higher than that of the steroid and dry needling groups (p<0.05). At the end of the 6th month, there was no significant difference between the steroid group and the dry needling group in terms of VAS, AOFAS and RMS scores (p>0.05). Corticosteroid administration is beneficial in the early phase of chronic plantar fasciitis treatment. In long-term follow-up, we can say that PRP application is a more effective method on pain and functional results compared to steroid and dry needling.