Skip to main content
Egyptian Rheumatology and Rehabilitation
Download PDF

Platelet-rich plasma versus dry needling of myofascial meridian trigger points in the treatment of plantar fasciitis

Egyptian Rheumatology and Rehabilitation volume 44, pages 58–68 (2017)Cite this article

Abstract

Background

Plantar fasciitis (PF) is the most common cause of heel pain, which results from repetitive trauma with degenerative changes in the plantar tissue. Platelet-rich plasma (PRP) and dry needling showed promising results as regards pain resolution and healing effect, and hence our aim was to compare their efficacy in the treatment of chronic PF.

Patients and methods

Thirty patients diagnosed with unilateral PF were subjected to full clinical assessment for foot function using the foot function index (FFI) and assessment of trigger points along the meridians. Ultrasonographic examination of plantar fascia thickness, echogenicity, and power Doppler was carried out. Patients were divided randomly into two groups of 15 each: group A received a single injection of PRP at the plantar fascia, and group B was treated with dry needling protocol in myofascial meridians trigger points along the superficial back line. Follow-up after 6 and 12 weeks included clinical re-evaluation, FFI determination, and ultrasonography. Our results showed a significant improvement in the clinical outcome of the FFI in group B (P<0.03) and a highly significant improvement in the clinical outcome within the PRP group by the 12th week (P<0.009). A significant decrease in thickness, heterogeneity, and Doppler signals (P<0.04, P<0.003, and P<0.03, respectively) was observed within the PRP group at the 12th week.

Conclusion

PRP injection is a promising line of treatment for chronic PF with documented ultrasonographic healing effect. Dry needling is a simple and safe technique for treating pain associated with PF, yet it is more invasive and less effective compared with PRP injection.

References

  1. Kumar V, Millar T, Murphy NM, Clough T. The treatment of intractable plantar fasciitis with platelet-rich plasma injection. Foot 2013; 23:74–77.

    Article  Google Scholar 

  2. Barrett SL, Erredge SE. Growth factors for chronic plantar fasciitis. Podiatry Today 2004; 17:37–42.

    Google Scholar 

  3. McMillan AM, Landorf KB, Gilheany MF, Bird AR, Morrow AD, Menz HB. Ultrasound guided corticosteroid injection for plantar fasciitis: randomized controlled trial. BMJ 2012; 22:344–3260.

    Google Scholar 

  4. Urovitz EP, Urovitz AB, Urovitz EB. Endoscopic plantar fasciotomy in the treatment of chronic heel pain. Can J Surg 2008; 51: 281–283.

    PubMed  PubMed Central  Google Scholar 

  5. Sampson S, Gerhordt M, Mandelbaum B. Platelet rich plasma injection for MS injuries. Curr Rev MS Med 2008; 1:165–174.

    Google Scholar 

  6. Foster TE, Puskas BL, Mandebaum BR, Gerhardt MB, Rodeo SA. Platelet-rich plasma: from basic science to clinical application. Am J Sports Med 2009; 37:1112–1115.

    Article  Google Scholar 

  7. Gruber P, Varga E, Fisher M. Platelets stimulate proliferation of bone cells: involvement of platelet derived growth factor, microparticles, and membranes. Clin Oral Implants Res 2002; 13:529–535.

    Article  Google Scholar 

  8. Crane D, Everts P. Platelet rich plasma (PRP) matrix graphs. Pract Pain Manag 2008; 8:12–26.

    Google Scholar 

  9. Peerbooms JC, van Laar W, Faber F, Schuller HM, van der Hoeven H, Gosens T. Use of platelet rich plasma to treat plantar fasciitis: design of a multi Centre randomized controlled trial. BMC Musculoskelet Disord 2010; 11:69.

    Article  Google Scholar 

  10. Simons DG. New views of myofascial trigger points: etiology and diagnosis. Arch Phys Med Rehabil 2008; 89:157–159.

    Article  Google Scholar 

  11. Perez-Millan R, Foster L. Low frequency electroacupuncture in the management of refractory plantar fasciitis. Med Acupunct 2001; 13:1–6.

    Google Scholar 

  12. Nguyen BM. Trigger point therapy and plantar heel pain: a case report. Foot 2010; 20:158–162.

    Article  Google Scholar 

  13. Cotchett MP, Landorf KB, Munteanu SE, Raspovic AM. Effectiveness of dry needling and injections of myofascial trigger points associated with plantar heel pain: a systematic review. J Foot Ankle Res 2010; 3:18.

    Article  Google Scholar 

  14. McPoil TG, Martin RL, Cornwall MW, Wukich DK, Irrgang JJ, Godges JJ. Heel pain-plantar fasciitis: clinical practice guidelines linked to the international classification of function, disability, and health from the orthopaedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther 2008; 38:A1–A18.

    Article  Google Scholar 

  15. Budiman-Mak E, Conrad KJ, Roach KE. The Foot Function Index: a measure of foot pain and disability. J Clin Epidemiol 1991; 44:561–570.

    Article  CAS  Google Scholar 

  16. Chang C-W, Wang Y-C, Hou W-H, Lee X-X, Chang K-F. Medial calcaneal neuropathy is associated with plantar fasciitis. Clin Neurophysiol 2007; 118:119–123.

    Article  Google Scholar 

  17. Sabir N, Demirlenk S, Yagci B, Karabulut N, Cubukcu S. Clinical utility of sonography in diagnosing plantar fasciitis J Ultrasound Med 24 2005; 1041–1048.

    Article  Google Scholar 

  18. Mahindra P, Yamin M, Selhi HS, Singla S, Soni A. Chronic plantar fasciitis: effect of platelet-rich plasma, corticosteroid, and placebo. Orthopedics 2016; 39:e285–e289.

    Article  Google Scholar 

  19. Imamura M, Fischer AA, Imamura ST, Kaziyama HS, Carvalho AE, Salomao O. Treatment of myofascial pain components in plantar fasciitis speeds up recovery: documentation by algometry. J Musculoskelet Pain 1998; 6:91–110.

    Article  Google Scholar 

  20. Behnam A, Mahyar S, Ezzati K, Mohammadi Rad S. The use of dry needling and myofascial meridians in a case of plantar fasciitis. J Chiropr Med 2014; 13:43–48.

    Article  Google Scholar 

  21. Clinton Miller M, Knapp RG. Clinical epidemiology and biostatistics. 3rd ed. Maryland: Lippincott Williams & Wilkins; 1992.

    Google Scholar 

  22. Cotchett M, Landorf K, Munteanu S. Effectiveness of trigger point dry needling for plantar heel pain: a randomized controlled trial. J Foot Ankle Res 2013; 6(Suppl 1):8.

    Article  Google Scholar 

  23. Buchbinder R. Clinical practice: plantar fasciitis. N Engl J Med 2004; 350:2159–2166.

    Article  CAS  Google Scholar 

  24. Lemont H, Ammirati K, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc 2003; 93:234–237.

    Article  Google Scholar 

  25. Barrett SL, Robert OM. Plantar fasciitis and other causes of heel pain. Am Fam Physician 1999; 59:2200–2206.

    CAS  PubMed  Google Scholar 

  26. Fenwick SA, Hazleman BL, Riley GP. The vasculature and its role in the damaged and healing tendon. Arthritis Res 2002; 4:252– 260.

    Article  Google Scholar 

  27. Molloy T, Wang Y, Murrell G. The roles of growth factors in tendon and ligament healing. Sports Med 2003; 33:381–394.

    Article  Google Scholar 

  28. Tiwari M, Bhargava R. Platelet rich plasma therapy: a comparative effective therapy with promising results in plantar fasciitis. J Clin Orthop Trauma 2013; 4:31–35.

    Article  Google Scholar 

  29. Martin RL, Irrgang JJ. A survey of selfreported outcome instruments for the foot and ankle. J Orthop Sports Phys Ther 2007; 37: 72–84.

    Article  Google Scholar 

  30. Tillu A, Gupta S. Effect of acupuncture treatment on heel pain due to plantar fasciitis Acupunct Med 1998; 16:66–68.

    Google Scholar 

  31. Cotchett MP, Munteanu SE, Landorf KB. Effectiveness of trigger point dry needling for plantar heel pain: a randomized controlled trial. Phys Ther 2014; 94:1083–1094.

    Article  Google Scholar 

  32. Tsai WC, Wang CL, Tang FT, Hsu TC, Hsu KH, Wong MK. Treatment of proximal plantar fasciitis with ultrasound-guided steroid injection. Arch Phys Med Rehab 2000; 81:1416–1421.

    Article  CAS  Google Scholar 

  33. Cunnane G, Brophy DP, Gibney RG, Fitz Gerald O. Diagnosis and treatment of heel pain in chronic inflammatory arthritis using ultrasound. Semin Arthritis Rheum 1996; 25:383–389.

    Article  CAS  Google Scholar 

  34. Morihisa R, Eskew J, McNamara A, Young J. Dry needling in subjects with muscular trigger points in the lower quarter: a systematic review. Int J Sports Phys Ther 2016; 11:1–14.

    PubMed  PubMed Central  Google Scholar 

  35. Mark W. Platelet-rich plasma injection for proximal plantar fasciitis. Tech Foot Ankle 2011; 10:7–10.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Ain Shams University, 11331, Cairo, Egypt

    Reem M. El Mallah, Enas A. Elattar & Howayda F. Zidan

Authors
  1. Reem M. El Mallah
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Enas A. Elattar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Howayda F. Zidan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Reem M. El Mallah.

Additional information

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work noncommercially, as long as the author is credited and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

El Mallah, R.M., Elattar, E.A. & Zidan, H.F. Platelet-rich plasma versus dry needling of myofascial meridian trigger points in the treatment of plantar fasciitis. Egypt Rheumatol Rehabil 44, 58–68 (2017). https://doi.org/10.4103/1110-161X.205661

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/1110-161X.205661

Keywords