Carlton J. Covey, MD; Mark D. Mulder, MD The Nellis Family Medicine Residency, Nellis Air Force Base, Nev (Drs. Covey and Mulder); Department of Family Medicine at the Uniformed Services University of the Health Sciences, Bethesda, Md (Dr. Covey) carlton.covey@nellis.af.mil
The authors reported no potential conflict of interest relevant to this article.
The opinions and assertions contained herein are the private views of the authors and are not to be construed as official, or as reflecting the views of the US Air Force Medical Service or the US Air Force at large.
To date, no trials have compared PRP with placebo injections. Postprocedural pain is the most common risk with PRP. While limited evidence exists, PRP seems to be a relatively safe and effective therapeutic alternative for treating chronic PF.
Surgery only when conservative measures fail Reserve surgery for those who have not responded adequately after 6 to 12 months of conservative therapy.5 Endoscopic plantar fascia release is superior to traditional open surgery.31 Heel spur resection is no longer routinely practiced. Patients undergoing surgery should expect a return to normal activity in approximately 2 to 3 months, and up to 35% of patients may continue to have symptoms after surgical intervention.2,31
Treatment options in perspective
Treat conservatively at first. Stretching the plantar fascia and heel cord, using prefabricated orthotics, and wearing night splints are backed by firm clinical evidence of benefit. Acute treatment of PF may also include CSI, especially for patients who are athletic or otherwise active and wish to return to full function as soon as possible, and are willing to accept the risks associated with CSI.
ESWT improves pain and function scores and may also relieve pain in patients with recalcitrant PF pain. PRP has limited but promising evidence for patients with chronic PF pain. Surgical intervention remains the last line of therapy and is not always effective at reducing pain.
CASE You prescribe a conservative treatment program of plantar fascia–specific stretches and prefabricated orthoses for the patient in the opening scenario. At one month, her pain drops by 30%. At 6 months, her pain disappears, and she resumes a daily aerobic exercise program to assist in weight loss.
CORRESPONDENCE Carlton J. Covey, MD, Nellis Family Medicine Residency, 99MDOS/SGOF, 4700 Las Vegas Boulevard N, Las Vegas, NV 89191; carlton.covey@nellis.af.mil
