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Platelet Rich Plasma application for Plantar Fasciitis (Read 133 times)

Amannrunner


    I'm not sure how rare this treatment is, but has anyone tried this? It's called platelet rich plasma application or Autologous Conditioned Plasma (ACP) treatment. I want to bring it up to my orthapedic surgeon because I was already going to ask her about shock wave therapy, but I don't want to sound like an idiot =). I've had plantar fasciitis for over 2 years now and pretty much tried everything. The only thing that gets rid of it is not running or walking for a long time. I can't stop walking because I work in a clinical setting. I have tried not running for 6-7 months and that seemed to help, but it just comes back once I start running again.


    just a simple cat

      Isn't that the treatment that Kim Kardashian had done to her face?

       

      http://www.nydailynews.com/entertainment/tv-movies/kim-kardashian-vampire-facelift-bloody-mess-article-1.1285646

       

      ...seems like snake oil to me.

       

       

      Have you tried acupuncture?

       

      I  guess as you get more bodacious, you begin to lose more brain cells, because there is a limit to how much magnificence your body can house

      skygazer


        I've read it's pretty effective but the therapy so far is pretty much limited to elites (professional athletes) or those who got money to spend as it's quite expensive and not covered by insurance (not a standard medical procedure).


        Feeling the growl again

          I've read it's pretty effective but the therapy so far is pretty much limited to elites (professional athletes) or those who got money to spend as it's quite expensive and not covered by insurance (not a standard medical procedure).

           

          IE people who will do anything and everything to get rid of the issue, or those with deep pockets who will do the same.

           

          I looked into this for another thread a couple years ago, I could find no real scientific evidence to support this.

           

          To the OP - What kind of shoes do you wear everyday at work?

          "If you want to be a bad a$s, then do what a bad a$s does.  There's your pep talk for today.  Go Run." -- Slo_Hand

           

            It is as popular as heck in the sports medicine world - several of the Green Bay Packers in town her have done it and many of the docs I work with in my medical device sales job use it with success. I had it done about 3 months ago for my bilateral upper hamstring tendonosis. It was $1000. I was going to pay out of pocket if insurance did not cover.  I have United Healthcare and I paid $20 office visit fee. I was required to put down $250. The clinic sent back $230. They covered it for me but doc helped out with a nice medical necessity letter. I have had this issue for nearly 6 years.

             

            I don't think it is snake oil. There is some level one evidence of effectiveness for elbow tendonosis.  In theory, it makes sense that it could work but certainly not a cure for everyone.  They take blood out of your arm. Put it in a centrifuge and then shake out the platelet rich plasma out of that. I had a bit more blood taken out as I had both sides injected. I had the blood  injected directly into both tendons under ultrasound guided injections to ensure it went in the tendon and not in lost in soft tissue. The doc also picked at the tendon multiple times with the needle to illicit a bleeding or inflammatory response. My doc has had very positive outcomes - she mainly uses it the most common areas like elbow tendonosis and Achilles tendonosis.  I was her first upper hammy tendonosis case.

             

            For me, I have a ton of scar tissue especially on right side as seen on the diagnostic ultrasound. This is a source of pain. BUT, I feel better than I have in about 2 years. The platelets are active for up to 3-4 months. I noticed the most improvement between 8-12 weeks. I am not suddenly cured and still have soreness but I have noticed improvement especially on my right side which the doc said was a complete mess. My runs are less painful and sitting is less painful and I have increased my miles. Here is the company I used after researching them all.

            http://www.harvesttech.com/products/whatisprp.html

             

            NOTE:  Not all clinics/docs will do this. It cost money to get the machine and also purchase a musculoskeletal ultrasound device. You need to do some research. Look for someone experienced.

             

            NOTE:  My doc also does a procedure called, FAST Technique http://www.fast-technique.com/  I know she did a patient last week with chronic plantar fasciitis. This is something I would consider down the road as this procedure sucks out the source of pain - SCAR TISSUE.

            Those who try, fail! Those who do what it takes to succeed, succeed!!

            skygazer


              Techniques in Foot & Ankle Surgery:

              March 2011 - Volume 10 - Issue 1 - p 7–10

              doi: 10.1097/BTF.0b013e31820b4b63

              Platelet-rich Plasma Injection for Proximal Plantar Fasciitis

              http://journals.lww.com/techfootankle/Fulltext/2011/03000/Platelet_rich_Plasma_Injection_for_Proximal.4.aspx

               

              "In the last 10 years, there has been an increased use of platelet-rich plasma (PRP) for a myriad of enthesopathies taking advantage of the body's autologous platelets to stimulate the inflammatory response and promote organized healing, remodeling, and maturation of fibroblasts.1,2" (read on to the part "PHYSIOLOGY OF TISSUE HEALING" if you're interested in the theory behind the application).

               

              "The use of concentrated platelets injected with or without thrombin as an activator has proven useful in the treatment of plantar fasciitis, lateral epicondylitis, Achilles tendinosis, and trochanteric bursitis.7...."

               

              (There're some situations not suitable for the treatment. Please read it yourself.)

               

               

              ---------------------------------

              Some tendons/ligaments like Achilles tendon or plantar fascia have very little blood circulation to them. That make the healing process of the fiber tears much slower than that in the muscles. In theory, this therapy may work. Clinically, it has been reported with some success. If my PF was really bad and stubborn like some cases I've read about, I might have given it a try. But fortunately, my PF went away while I doubled up my training load.

              skygazer


                Some scientific support:

                Use of platelet rich plasma to treat plantar fasciitis - BioMed Central

                 

                http://www.ncbi.nlm.nih.gov/pubmed/22555761

                "CONCLUSION:

                Injection of PRP is safe and doesn't affect the biomechanical function of the foot. Our successful early findings with injection of PRP indicate that this may become a very commonly used modality in treating this difficult condition."

                 

                 

                http://www.ncbi.nlm.nih.gov/pubmed/22512103

                "CONCLUSION:

                The use of PRP in patients with Achilles tendinopathy and plantar fasciitis is an effective and safe alternative for the management of patients with a poor response to conventional non-surgical treatment. Other non-surgical modalities are recommended besides PRP for the treatment of these patients to achieve appropriate results.


                Refurbished Hip

                  I have not had a PRP injection, but I looked into having it done after dealing with a tendon/groin injury that wouldn't heal.  Amazingly, my insurance was going to cover it and I was ready to schedule an appointment, but I've been having great luck getting Graston from my chiropractor.  Have you looked into Graston at all?  I think people have had success with it for PF.  If my healing stalls or I start to regress backwards, I'll be back to looking at the PRP injections again.

                   

                  Hope you get it figured out!

                  Amannrunner


                    No I haven't looked into Graston. I will look it up! Did you have to do anything special to get your insurance to cover PRP?

                    Thanks for the tip!

                    Amannrunner


                      I have United Healthcare too. If I decide to go through with the treatment and need help getting insurance to cover it, could I PM you and maybe you could help the doctor and I with the medical necessity letter? Thanks for the response!

                      It is as popular as heck in the sports medicine world - several of the Green Bay Packers in town her have done it and many of the docs I work with in my medical device sales job use it with success. I had it done about 3 months ago for my bilateral upper hamstring tendonosis. It was $1000. I was going to pay out of pocket if insurance did not cover.  I have United Healthcare and I paid $20 office visit fee. I was required to put down $250. The clinic sent back $230. They covered it for me but doc helped out with a nice medical necessity letter. I have had this issue for nearly 6 years.

                       

                      I don't think it is snake oil. There is some level one evidence of effectiveness for elbow tendonosis.  In theory, it makes sense that it could work but certainly not a cure for everyone.  They take blood out of your arm. Put it in a centrifuge and then shake out the platelet rich plasma out of that. I had a bit more blood taken out as I had both sides injected. I had the blood  injected directly into both tendons under ultrasound guided injections to ensure it went in the tendon and not in lost in soft tissue. The doc also picked at the tendon multiple times with the needle to illicit a bleeding or inflammatory response. My doc has had very positive outcomes - she mainly uses it the most common areas like elbow tendonosis and Achilles tendonosis.  I was her first upper hammy tendonosis case.

                       

                      For me, I have a ton of scar tissue especially on right side as seen on the diagnostic ultrasound. This is a source of pain. BUT, I feel better than I have in about 2 years. The platelets are active for up to 3-4 months. I noticed the most improvement between 8-12 weeks. I am not suddenly cured and still have soreness but I have noticed improvement especially on my right side which the doc said was a complete mess. My runs are less painful and sitting is less painful and I have increased my miles. Here is the company I used after researching them all.

                      http://www.harvesttech.com/products/whatisprp.html

                       

                      NOTE:  Not all clinics/docs will do this. It cost money to get the machine and also purchase a musculoskeletal ultrasound device. You need to do some research. Look for someone experienced.

                       

                      NOTE:  My doc also does a procedure called, FAST Technique http://www.fast-technique.com/  I know she did a patient last week with chronic plantar fasciitis. This is something I would consider down the road as this procedure sucks out the source of pain - SCAR TISSUE.


                      Refurbished Hip

                        No, I didn't have to do anything special to get my insurance to cover the PRP injections -- I think I just got lucky, as this is where I go: http://www.uwhealth.org/sports-medicine/platelet-rich-plasma-prp-injections/20887  When I called for pricing before I knew if my insurance would cover it, I was quoted around $2000 for the injection if it required imaging.  (Yikes.)

                         

                        However, if I were you, I would definitely look into Graston.  http://www.grastontechnique.com/LocateaProvider.html

                         

                        It's usually done by a PT or chiropractor.  When I started, I couldn't run at all, after having been off for 4 months.  I've had 8 Graston/ART sessions so far and as you can see from my log, I'm slowly working my way back into things.  The Graston itself is pretty damn painful, but it's been very worth it for  me.


                        Feeling the growl again

                          Some scientific support:

                          Use of platelet rich plasma to treat plantar fasciitis - BioMed Central

                           

                          http://www.ncbi.nlm.nih.gov/pubmed/22555761

                          "CONCLUSION:

                          Injection of PRP is safe and doesn't affect the biomechanical function of the foot. Our successful early findings with injection of PRP indicate that this may become a very commonly used modality in treating this difficult condition."

                           

                           

                          http://www.ncbi.nlm.nih.gov/pubmed/22512103

                          "CONCLUSION:

                          The use of PRP in patients with Achilles tendinopathy and plantar fasciitis is an effective and safe alternative for the management of patients with a poor response to conventional non-surgical treatment. Other non-surgical modalities are recommended besides PRP for the treatment of these patients to achieve appropriate results.

                          Well, the first article you linked in the post I did not quote included no clinical evidence, and the only source I clicked on it it that did was a case study on 3 patients.  The above two studies were non-randomized studies in only 10 and 25 patients, respectively.  This is really not robust scientific evidence.  You post the conclusions but it is the clinical design and sample size which give studies validity.  These seem to provide support for conducting a real randomized trial of appropriate power to answer the question, but I have not been able to find one that has been done.

                          "If you want to be a bad a$s, then do what a bad a$s does.  There's your pep talk for today.  Go Run." -- Slo_Hand

                           

                          Amannrunner


                            Thanks for the tip. I will definitely look into Graston. It looks like there a several providers in my area. =)

                            No, I didn't have to do anything special to get my insurance to cover the PRP injections -- I think I just got lucky, as this is where I go: http://www.uwhealth.org/sports-medicine/platelet-rich-plasma-prp-injections/20887  When I called for pricing before I knew if my insurance would cover it, I was quoted around $2000 for the injection if it required imaging.  (Yikes.)

                             

                            However, if I were you, I would definitely look into Graston.  http://www.grastontechnique.com/LocateaProvider.html

                             

                            It's usually done by a PT or chiropractor.  When I started, I couldn't run at all, after having been off for 4 months.  I've had 8 Graston/ART sessions so far and as you can see from my log, I'm slowly working my way back into things.  The Graston itself is pretty damn painful, but it's been very worth it for  me.

                              I've read it's pretty effective but the therapy so far is pretty much limited to elites (professional athletes) or those who got money to spend as it's quite expensive and not covered by insurance (not a standard medical procedure).

                               

                              I looked into PRP last fall.  I've had chronic Achilles Tendonothopy for about 3 years.  You name- I've tried it....multiple PT sessions, heat, ice, sports massage, ultrasound, Graston, yoga, stretching, slant board, MIRs, prayer beads.

                               

                              I was quoted $200 per injection. No insurance coverage.  I haven't made the decision to go with this yet, mainly because the Achilles feels pretty good these days.  Not healed, but much better.

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