Study Overview This study by Chew et al. that involved 54 patients with unilateral chronic plantar fasciitis for over four months. The participants were randomly divided into three groups:

• ACP Group: Received autologous conditioned plasma injection combined with conventional treatment.
• ESWT Group: Underwent extracorporeal shockwave therapy alongside conventional treatment.
• Conventional Treatment Group: Managed with stretching exercises and orthotics alone.

The study assessed outcomes at baseline, 1 month, 3 months, and 6 months post-treatment using the Visual Analog Scale (VAS) for pain, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale for function, and ultrasound to measure plantar fascia thickness.

Comparative Outcomes

1. Pain Relief (VAS Scores):

   • The ACP group experienced significant pain reduction at 1 month compared to conventional treatment (p = 0.037).
   • ESWT showed sustained pain relief at 1, 3, and 6 months compared to conventional treatment (p-values of 0.017, 0.022, and 0.042, respectively).
   • There was no significant difference between ACP and ESWT in overall pain reduction.

2. Functional Improvement (AOFAS Scores):

   • ACP improved AOFAS scores significantly at 3 and 6 months (p = 0.004 and p = 0.013, respectively) compared to conventional treatment.
   • ESWT showed significant functional improvements at 1 and 3 months (p = 0.011 and p = 0.003) over conventional treatment.
   • No significant difference was noted between ACP and ESWT in terms of functional improvement.

3. Plantar Fascia Thickness Reduction:

   • ACP led to a greater reduction in plantar fascia thickness compared to both ESWT and conventional treatment at 3 and 6 months (p-values of 0.019 and 0.027, respectively).
   • ESWT and conventional treatment showed similar results in fascia thickness reduction.

Conclusion Both ACP and ESWT provided superior outcomes compared to conventional treatment alone.

ACP is a PRP "like" injection with a total platelet dose that is lower than typical PRP injections provided by higher dose orthopedic systems. In this study, the ACP injections was still effective in promoting plantar fascia healing, while ESWT offered more sustained pain relief. For patients seeking long-term structural improvement, an autologous platelet injection may be the preferred choice, whereas ESWT is beneficial for immediate and sustained pain reduction. This study highlights the importance of patient-specific treatment selection based on symptom duration and severity.

References

Chew KT, Leong D, Lin CY, Lim KK, Tan B. Comparison of autologous conditioned plasma injection, extracorporeal shockwave therapy, and conventional treatment for plantar fasciitis: a randomized trial. PM R. 2013 Dec;5(12):1035-43.

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