LOCAL CORTICOSTEROID VS. AUTOLOGOUS BLOOD FOR PLANTAR FASCIITIS

BACKGROUND \nPlantar fasciitis is the most common cause of heel pain for which professional care is sought. Initially thought of as an \ninflammatory process, plantar fasciitis is a disorder of degenerative changes in the fascia and maybe more accurately termed \nplantar fasciosis. Traditional therapeutic efforts have been directed at decreasing the presumed inflammation. These treatments \ninclude icing, Nonsteroidal Anti-inflammatory Drugs (NSAIDs), rest and activity modification, corticosteroids, botulinum toxin \ntype A, splinting, shoe modifications and orthosis. Other treatment techniques have been directed at resolving the degeneration \ncaused by the disease process. In general, these techniques are designed to create an acute inflammatory reaction with the \ngoal of restarting the healing process. These techniques include autologous blood injection, Platelet-Rich Plasma (PRP) injection, \nnitroglycerin patches, Extracorporeal Shock Wave Therapy (ESWT) and surgical procedures. Recently, research has focused on \nregenerative therapies with high expectations of success. The use of autologous growth factors is thought to heal through \ncollagen regeneration and the stimulation of a well-ordered angiogenesis. These growth factors are administered in the form of \nautologous whole blood or Platelet-Rich Plasma (PRP). Platelets can be isolated using simple cell-separating systems. The \ndegranulation of the alpha granules in the platelets releases many different growth factors that play a role in tissue regeneration \nprocesses. Platelet-derived growth factor, transforming growth factor-P, vascular-derived endothelial growth factor, epithelial \ngrowth factor, hepatocyte growth factor and insulin-like growth factor are examples of such growth factors. Injections with \nautologous growth factors are becoming common in clinical practice. The present study was an attempt to compare the efficacy \nof autologous blood injection in plantar fasciitis by comparing it with the local corticosteroid injection. \nMATERIALS AND METHODS \nA total of 120 patients who attended Orthopaedic OPD at Government General Hospital, Kakinada, during the time spanning \nJanuary 2015 to December 2015, who were suffering from plantar fasciitis were randomly allocated either autologous blood \ninjection or corticosteroid injection as treatment. Both groups were analysed with VAS and Nirschl pain staging at presentation, \n1 \nst week, 4 \nth week, 12 \nth week and at six-month intervals. Results were tabulated and analysed statistically. All patients were \ntreated on OPD basis. No inpatient care was needed in any patient. \nRESULTS \nIn this study, slight male preponderance was seen in both the groups (53.33%). The mean in group A was 41.80±10.96 years \nand in group B the mean age was 40.68±10.47 years. Most of the patients in group A and B presented with right foot \ninvolvement (51.67% and 65.00%). The mean duration in group A was 10.88 weeks compared to 8.62 weeks in group B. The \nmean VAS scores at the beginning were comparable in both the groups (7.55±1.40 vs. 7.70±1.14). At fourth week, the mean \nVAS score in group A significantly reduced to 3.18±2.38 and at 12 weeks and six months to 0.3±1.37 suggesting significantly \nless pain in group A compared to group B. Similar trend of reduction among patients is group A was observed with Nirschl \nstaging scores. No patient in group A reported complications and recurrence was not observed in patients with group A. \nCONCLUSION \nBased on the results of our present study, it maybe concluded that autologous blood injection significantly reduced the pain \nbased on VAS and Nirschl staging without complications there by lowering the recurrence rate up to six months in patients with \nplantar fasciitis. It also provided complete relief of pain for the period of six months without any complication. Autologous blood \nis simple to acquire and prepare, easy to carry out. Hence, autologous blood provides intermediate and long-term results in \nterm of pain relief when compared to corticosteroid injection, which gives early and short-term relief of pain from plantar \nfasciitis.