PRP / Platelet-rich plasma
PRP (Platelet-rich plasma) may be beneficial for plantar fasciitis, Achilles tendinopathy. The use of autologous platelet-rich plasma (PRP) has emerged as a orthobiologic tool for foot and ankle specialists. Researchers have investigated the use of PRP in the treatment of tendon injuries, chronic wounds, ligamentous injuries, cartilage injuries, muscle injuries and for bone augmentation (intraoperative fusions and fracture repair).
In theory, PRP offers increased concentrations of platelets, which yield high concentrations of growth factors and other proteins that will subsequently lead to enhanced healing of soft tissue on a cellular level. Platelet-rich plasma is a concentration of platelets derived from the plasma portion of centrifuged or filtered autologous (patient’s own) blood.
There have been several basic science reviews and studies as well as clinical studies on PRP. There are both in vitro and in vivo studies. Animal and human studies have examined the benefits and safety of PRP. Many of these studies have adequately shown the safety and efficacy of PRP in the clinical and surgical setting.
Foot and ankle applications for PRP fall into several categories. These categories include: acute and chronic ligamentous injuries, chronic tendinopathy (tendinosis), bone pathology, chronic wounds and cartilage injury.
PRP For Plantar Fasciitis
Patients may be candidates for PRP if they have failed conservative treatments after three to six months. The conservative treatments include rest, ice, compression, elevation, functional foot orthotics, physical therapy and cortisone injections.
Histologic studies of patients with chronic recalcitrant plantar fasciitis show little signs of acute inflammation. Rather, there are chronic degenerative changes, fibrosis, collagen degeneration and evidence of impaired vasculature. PRP is aimed at creating an acute injury in the presence of platelets and other growth factors important in tissue repair.
PRP For Achilles Tendinopathy And Rupture Repair
Achilles tendon injury leads to a cascade of degenerating events, including hypovascularity, repetitive microtrauma and the addition of fibrous tissue, which can then lead to degeneration and weakness of the tendon. This eventually leads to rupture. In theory, PRP reverses the effects of tendinopathy by stimulating the revascularization and improving healing at the microscopic level.
The hypothesis is that the introduction of PRP into the pathologic tendon will aid in the repair and remodeling of the tendon by tenocytes. Those patients who have failed conservative therapies after three to six months are good candidates.
Platelet-rich plasma has promise for the treatment of many foot and ankle pathologies. These pathologies include tendinopathy and ligamentous/fascial injury. This is an office based, minimally invasive treatment which allows a faster return to activity than conventional surgical intervention. The results of this treatment option have been increasingly promising with regard to decreased pain, increased activity, improved function, faster recovery and increased strength. The use of PRP in the clinical setting may be advantageous for its ease of use, relative availability, low side effects and tolerability in comparison to more invasive techniques.