Autologous Conditioned Plasma (ACP) versus Corticosteroid Injections for Plantar Fasciitis: A Randomized Trial

OBJECTIVES: Plantar fasciitis is a chronic, degenerative breakdown of the plantar fascia that spans the bottom surface of the foot. The injury is associated with point tenderness at the medial side of the heel and pain and tightness with weight bearing. Corticosteroid (CS) injections are a fairly common treatment option after exhausting all other non-operative treatments. Autologous conditioned plasma (ACP) injections may optimize the healing environment for tissue regeneration and repair which may provide greater improvements in pain and function compared to corticosteroid injections. Thus, the purpose of this study was to compare the pain, function and quality of life in patients who have received an ACP injection versus a corticosteroid injection for the treatment of plantar fasciitis. METHODS: We conducted a randomized controlled trial in patients with plantar fasciitis who were referred to our clinic from local primary care physicians. Patients were stratified by symptom duration (less than and greater than three months) and received either an ACP or CS injection. We measured outcomes at two weeks, six weeks, three months, six months, and one year. Our primary outcome was the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale; secondary outcomes included the SF-12v2 Health Survey and the Plantar Fasciitis Pain and Disability scale. We used an analysis of covariance to analyze all outcomes. We calculated the adjusted between-group mean difference with 95% confidence interval and associated probability values. RESULTS: A total of 126 patients were included in the analysis (ACP = 64, CS = 62). For our primary outcome, at six months, the mean and standard deviation of the AOFAS Ankle-hindfoot scale was 67.1±18.3 for the ACP group and 70.8±17.6 for the CS group (mean difference -1.7, CI -7.6 to 4.2, p = 0.6). At one year, the mean and standard deviation was 72.3±19.1 for the ACP group and 75.6±17.0 for the CS group (mean difference -1.3 CI -7.3 to 4.6, p = 0.7). There was no statistically significant differences between treatment groups for any of the secondary outcome measures. CONCLUSION: ACP does not provide greater self-reported pain relief or function than CS injections in patients with plantar fasciitis. Given the know complications of repeated CA injections, ACP is a reasonable first line treatment option.