Ultrasonography-Guided Dextrose Prolotherapy Versus Platelet-Rich Plasma Injections for the Treatment of Plantar Fasciitis: A Randomized Controlled Trial.
Background: Heel pain is prevalent in foot and ankle practice, with plantar fasciitis being a common cause of chronic heel pain in adults. It is a degenerative condition of the plantar fascia, rendering the term fasciitis inaccurate. The condition has several alternative names, including painful heel syndrome and heel spur syndrome. It is found that a significant number of people suffer from plantar fasciitis at some stage of their lives; athletes and women between 40 and 60 years and adults aged more than 65 suffer the most. Patients typically report tenderness at the medial aspect of the heel, and pain is mostly under the surface of the heel, especially with initial morning steps. Plantar fasciitis is predominantly unilateral. Treatment options include prolotherapy and platelet-rich plasma (PRP), with this randomized controlled trial (RCT) aiming to evaluate the efficacy of PRP versus 25% dextrose prolotherapy in alleviating plantar fasciitis symptoms.
Objective: This study aimed to assess the comparative effectiveness of USG-guided 25% dextrose prolotherapy and autologous PRP injections on pain intensity, foot function, and ankle outcomes in plantar fasciitis cases.
Methods: The study took place at the Department of Physical Medicine and Rehabilitation (PMR), King George's Medical University (KGMU), Lucknow, Uttar Pradesh, India, with eligible patients evaluated. Group A received 25% dextrose prolotherapy, while Group B was administered autologous platelet-rich plasma. Outcome measures, including pain by Pain Intensity Scale (PIS) and assessment of disability by Foot Function Index (FFI) and Foot and Ankle Outcome Score (FAOS), were assessed at baseline and the third and sixth weeks after intervention.
Results: A total of 44 patients were randomized into two groups of 22. Group A received dextrose prolotherapy, while Group B was treated with PRP injections as per the study protocol. The average age of participants in our study was 36.10±10.0 years. Female participants were more affected than male participants in both groups. Overall, the male-female ratio was 38.6:61.4, while in Group A and Group B, this ratio was 45.5:54.5 and 31.8:68.2, respectively. The presentation of plantar fasciitis was bilateral (40.9%), on the right side (40.9%), and on the left side (18.2%). The right side was more frequently involved than the left side of the plantar fascia. There was a decrease in the average PIS score of Groups A and B at the baseline, which was 7.27±1.24 and 7.55±1.26, respectively, which was reduced to 3.18±1.30 and 2.50±0.67 after six weeks of follow-up. The average FFI score of Groups A and B at the baseline was 98.64±17.68 and 95.36±19.01, respectively, which was reduced to 79.77±12.77 and 63.77±18.50 after six weeks of follow-up. The average FAOS score of Groups A and B at the baseline was 71.36±13.95 and 74.86±28.72, respectively, which was reduced to 74.86±28.72 and 42.09±5.03 after six weeks of follow-up.
Conclusions: Both 25% dextrose prolotherapy and PRP injections are effective treatments for plantar fasciitis. Both are minimally invasive and safe treatments for plantar fasciitis.