Patient Selection Criteria In a recent study by Pandey et al. (2023) included 72 patients, aged 18-65, suffering from chronic plantar fasciitis for more than two months and with a pain intensity of at least 5 on the Visual Analog Scale (VAS). For patients to be included in this study, they were required to have failed conservative treatment, including physiotherapy, NSAIDs, and orthotic interventions. Those with systemic inflammatory diseases, prior foot surgery, neurological disorders, uncontrolled systemic diseases, or contraindications to ESWT or PRP were excluded.

Treatment Modalities

• ESWT Group: Patients received a single session of shockwave therapy, involving 2000 pulses at a frequency of 2 pulses per second with an intensity of 0.2 mJ/mm².
• PRP Group: Patients underwent ultrasound-guided PRP injections, with blood drawn and centrifuged to isolate platelet-rich plasma before injection into the plantar fascia. The PRP system used a low volume blood draw of 20ml of blood and no characterization of the PRP.

• Functional Improvement (AOFAS Scores)
  • ESWT provided an initial improvement by day 15 (AOFAS: 72.58) over PRP (AOFAS: 67.22) (p=0.016).
  • By day 90, PRP significantly outperformed ESWT (AOFAS: 81.08 vs. 72.75) (p<0.001).

• Plantar Fascia Thickness Reduction (PFT Measurements)

  • PRP led to a greater reduction in PFT over time (final PFT: 3.82mm) compared to ESWT (final PFT: 4.40mm) (p<0.001), indicating superior long-term structural improvement.

Conclusion The study confirms that both ESWT and PRP are effective for chronic plantar fasciitis, but their benefits vary over time. ESWT provides more immediate pain relief, making it suitable for patients seeking short-term improvement. PRP, on the other hand, demonstrates superior long-term benefits in pain reduction, functional recovery, and plantar fascia healing.

For patients requiring faster relief, ESWT may be preferred, while PRP maybe a better option for sustained recovery. One major limitation in this study is the authors only used a single shockwave session and a low dose PRP preparation with no analysis of the PRP dose. Both interventions were a lower dose that other studies have recommended, and follow up was short at only 90-days and effects of these treatments often take longer to see full results.

Future studies could explore the combined use of these therapies for optimized outcomes.

References

Pandey S, Kumar N, Kumar A, Biswas A, Sinha U, Pandey J, Ghosh S, Das S, Johnson RA, Kumar R, E V A, Kumari K. Extracorporeal Shockwave Therapy Versus Platelet Rich Plasma Injection in Patients of Chronic Plantar Fasciitis: A Randomized Controlled Trial From a Tertiary Center of Eastern India. Cureus. 2023 Jan 31;15(1):e34430.

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