Comparison of Autologous Conditioned Plasma Injection, Extracorporeal Shockwave Therapy, and Conventional Treatment for Plantar Fasciitis: A Randomized Trial
Abstract
Objective: To evaluate the efficacy of autologous conditioned plasma (ACP) compared to extracorporeal shockwave (ESWT) and conventional treatments for plantar fasciitis.
Design: Randomized trial
Setting: Sports medicine center in a tertiary care hospital.
Patients: 54 subjects (29-71 years) with unilateral chronic plantar fasciitis with greater than 4 months of symptoms.
Methods: Subjects randomized to three groups: 19 to ACP and conventional treatment (ACP group), 19 to ESWT and conventional treatment (ESWT group), and 16 to conventional treatment alone. Conventional treatment included stretching exercises and orthotics if indicated.
Main Outcome Measurements: Outcomes were pain Visual Analog Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, and ultrasound plantar fascia thickness assessed at baseline pre-treatment and at 1 month, 3 months and 6 months post-treatment.
Results: VAS, AOFAS, and plantar fascia thickness improved in all groups. Significant VAS pain score improvements in the ACP group compared with conventional treatments at the 1st 18 month (P=0.037) and for the ESWT group compared to conventional treatments at the 1st, 3rd and 6th 19 months (P=0.017, P=0.022, P=0.042). AOFAS score improved in the ACP group at the 3rd and 6th 20 months (P=0.004 and P=0.013) and for the ESWT group at the 1st and 3rd 21 months (P=0.011, P=0.003) compared to 22 conventional treatments. Significant improvements in plantar fascia thickness were seen in the ACP group at the 1st and 3rd month compared with conventional treatments (P=0.015, P=0.014) and at the 3rd 23 and 6th 24 months compared to the ESWT group (P=0.019, P=0.027). No adverse events reported.
Conclusions: Treatment of plantar fasciitis with ACP or ESWT plus conventional treatments resulted in 26 improved pain and functional outcomes compared with conventional treatments alone. There was no 27 significant difference between ACP and ESWT in terms of VAS and AOFAS improvements, although the 28 ACP group demonstrated greater reductions in plantar fascia thickness.