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Jain et al
Table 1. Inclusion and Exclusion Criteria.

Table 2. Distribution of Different Variables in 2 Groups.

Inclusion Criteria
1.
2.
3.
4.

Patients diagnosed with plantar fasciitis
Failure of conservative treatment (stretching exercises,
nonsteroidal anti-inflammatory drugs, and heel pads) for
at least 3 months
Patient should be able to understand the informed
consent
Visual analog scale pain higher than 5 (on a 10-point
visual analog scale)

Exclusion Criteria
1.
2.
3.

4
5
6

Any previous local injection treatment for heel pain
Any history of surgery for heel pain
Associated pathology involving the lower limb such as
- history of tarsal tunnel syndrome
- effusion of the ankle indicating an intra-articular
disease
- old healed calcaneal fracture
- Achilles tendinopathy
- any deformity of foot and ankle, including pes
planus or pes cavus
Patients with systemic disorder like diabetes mellitus,
rheumatoid arthritis, hematological disease, or gout
Pregnancy
Any recent history of aspirin or aspirin like drug intake

Platelet-rich plasma (PRP) is a concentrate of platelets,
which are a source of autologous growth factors. The cytokines present in the α-granules of the platelets have been
shown to enhance fibroblast migration and proliferation,
upregulate vascularization, and increase collagen deposition in a variety of settings.26 Based on these properties, the
injection of PRP into the affected tissue should promote
healing and reverse the degenerative processes that occur in
the origin of the plantar fascia.
This prospective randomized study was conducted to
compare the efficacy of local injection of corticosteroids
and PRP in the treatment of plantar fasciitis.

Methods
The study was conducted over a period of 2 years from June
2015 to May 2017. Approval from the hospital ethical and
scientific committee was obtained. Patients with a primary
diagnosis of plantar fasciitis who satisfied the inclusion and
exclusion criteria (Table 1) were recruited from the orthopedic outpatient department. Diagnosis of plantar fasciitis was
made on clinical grounds according to the guidelines
described by McPoil et al24 for plantar fasciitis. The following clinical findings were used to diagnose plantar fasciitis:
tenderness in the plantar medial heel region on palpation,
pain most noticeable with initial steps after a period of inactivity but also worse following prolonged weightbearing,

Variable
Age, y
Mean ± SD
Range
Sex, No.
Male
Female
BMI, kg/m2
Mean ± SD
Range
Duration of pain, mo
Mean ± SD
Range

Group A
(Steroid)

Group B
(PRP)

38.9 ± 9.5
24-61

37.7 ± 10.3
23 - 65

.581

26
14

20
20

.175

24.5 ± 3.3
16-30.7

23.7 ± 3.4
17.1-34.1

.282

7.6 ± 2.3
3-11

7.3 ± 2.9
3-15

.654

P Value

Abbreviations: BMI, body mass index; PRP, platelet-rich plasma.

and pain often precipitated by a recent increase in weightbearing activity.
Age, sex, height, weight, and types of shoe wear were
recorded. A detailed history of previous treatment, any previous injury to the foot, or the presence of any systemic
disease was recorded. Apart from routine investigations, a
lateral radiograph of the heel of the involved side was taken
to exclude any associated pathology and ultrasonography to
measure the thickness of the plantar fascia.
Patients were randomly allocated into 2 groups (group
assignments were determined by a computer-generated number sequence and were contained in sequentially numbered
opaque envelopes to ensure blinding) of 40 each (group A and
group B). Patients were treated with local corticosteroid injection in group A and autologous PRP injection in group B.
The mean age of patients in the steroid group (38.9 ± 9.5
[24-61] years) and in the PRP group (37.7 ± 10.3 [23-65]
years) was comparable (P = .581). There were equal number of male and female patients in the PRP group (n = 20
each), whereas the number of males (n = 26) was higher
than females (n = 14) in the steroid group (P = .175). The
mean BMI was 24.5 ± 3.3 (16-30.7) kg/m2 in the steroid
group and 23.7 ± 3.4 (17.1-34.1) kg/m2 in the PRP group
(P = .282). The mean duration of pain in both groups was
also comparable (P = .654) (Table 2).

Preparation of PRP
Under aseptic precautions, 27 mL of the patient's peripheral
whole blood was obtained using an 18-gauge needle. Then, 3
mL sodium citrate was added to the collected blood (in ratio
of 1:9), and around 3 mL PRP was extracted by a doublecentrifugation technique at 1300 rpm for 10 minutes to separate erythrocytes and then again at 3500 rpm for 10 minutes to
concentrate platelets15,29 using the Remi R-8C DX Laboratory
Centrifuge (Remi Electrotechnik Ltd, Maharashtra, India).

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