>Health and Nutrition>Platelet Rich Plasma application for Plantar Fasciitis
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!
Sure. PM me.
Those who try, fail! Those who do what it takes to succeed, succeed!!
You're right about there's a need of larger scale randomized studies as the application in sports medicine is rather new. But PRP is not a snake oil treatment. It has long been approved by FDA, though for OTHER applications (originally as a supplementary treatment after surgery to promote bone healing).
Sorry about the link(s) for scientific evidence. I opened several tabs at the same time and did copy&paste. I must have posted the wrong one because that one was just a research proposal to recruit volunteer patients for a clinic trial. I remember I thought not to paste that one since it has no result yet.
But the other two links (just triple click the http address to highlight the link then right click to choose how you want to browse it) are recently published researches with result. I left the link addresses to show they are from pubmed collection. Concerned forumites get to the link, would able able to see a list of related publications on the right (click on "see more..."). The conclusions I posted are from the researchers (not me) of the papers. There are also quite a few publications that had come out in the past few years and with more are on the way to publish on the application in soft tissues (tendons, ligaments, muscles, nerves, etc). One paper published this year (prepared in 2012) got to review 14 clinical studies on Achilles tendon injuries alone (you can find it at pubmed).
There are some caveat for those who are interested in giving it a try.
1. results are still mixed from published accounts (but better and safer than cortisone shots);
2. there seems NOT to be a standard application (to follow). Platelet conc. in an application can vary widely (usually from 2x to 8x as in normal whole blood). Partly, this conc. range reflects individual difference (some researches failed to take into account this variation, not that it's easy to design a trial for that). There are also different devices being used in different clinics too.
It is already known, more is not necessary better in terms of platelet or growth factors( the protein/hormone in charge of this healing treatment) The right conc. for someone else may not be the same as for you. One clinical study showed that normal blood injection (1x platelet conc.) gave as good or better results (the control group). Just sticking a needle there may cause similar healing process as you'd be bleeding at that spot. (is that how acupuncture cures some torn tissues?)
3. The best timing of the treatment is not yet known.
4. it is not pain free. The treatment can be very painful, for ~2weeks after injection. Though, it is a very safe treatment.
5. it may take more than 1 application (double/triple up the cost).
So, you don't jump at it until you've exhausted the conventional options (except surgery, and if isurance pays for it I'd try it before cortisone shot) and the pain has gone on for a while and you still haven't seen the light at the end of the tunnel.
This is the most comprehensive article on PF for runners that I have found on the internet.
Thanks for the site. It is well written. Still recovering from PF myself, and being at least adequate in reading the medical literature, here is my 2 cents FWIW.
1. PF is poorly understood, and there are likely many causes
2. This makes since, as there are many ways to stress this area
3. Therefore, there are many potential ways to treat, and prevent.
4. There is nothing better than a person who is open minded about trying different things until (hopefully) you find what works.
5. Someone who knows feet, running, and a variety of treatments is invaluable, but also hard to find.
Best of luck. By the way, tried Graston, stretching, Strassburg sock, PT, insoles, rest, time. Finally can run a small bit, but at least don't need to crawl in the morning.
Stay healthy, stay running
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Correct me if I'm wrong, but PRP treatment is not FDA approved nor regulated as its an autologous infusion, and not a drug. What the FDA has reviewed and approved thus far are the machines that are used (to concentrate the platelets). Frankly I'm not even sure there is a pathway for FDA approving this type of treatment.
I agree that the research is equivocal. The case reports also seem to vary by condition/location so I'd be surprised if this were something that had broad clinical utility. After having had my own personal journey through podiatry and orthopedic clinics, I've decided to abide by the advice from my orthopedic surgeon...dont let anyone inject your foot with anything.
Race Less Train More
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.
I started running on grass or trails. PF pretty much subsided. Running a quarter mile oval is boring but it has help. Two road marathons this month with no PF issues. 50k Saturday on trails. Steel toe work boots 10+ hours a day does not help. I am pretty sure the work boots cause the PF.
Run until the trail runs out.
Running on grass, soft surfaces, or barefoot have been promoted to either prevent or cure PF. I think there may be something with barefoot running once PF has resolved. It may strengthen weak muscles, and would be beneficial if that was the cause. It comes down to the cause. I'm glad it worked for you, and I think it is worthwhile for the OP to try. It didn't help me much.
You're right that the devices are FDA approved and the treatment doesn't need FDA approval in the case it is NOT claimed to be a cure.
Also, FDA introduced new rules that classify certain autologous cells, PRP treatment included, as biologic "drugs", hence under its regulation (21 CFR 1271). There has been a trend of new researches/treatments going in the direction of cell based medication. I guess the intention was to start setting rules for these new drugs/treatments (e.g. stem cells).
BTW, PRP is not 100% risk free. However, regardless its effectiveness or lack thereof, there's a consensus that it's a safe treatment. Your doctor might have over addressed the case (it is well known that cortisone injection can damage the ligament/tendon if not done properly).