I get angry when I see people falling for flashy procedures that fool them into thinking they’re fixing their problems. One of the most searched for heel pain treatments online over the last two years is one often featured in the sports section. Recent stories on Bartolo Colon, the Pittsburgh Steelers, and Tiger Woods are helping to popularize the concept of PRP, or Platelet-Rich Plasma, as the orthopaedic treatment of the moment for sprain and ligament issues.
There’s one minor problem with PRP: there’s no evidence it actually works.
PRP involves drawing blood from the patient and using a centrifuge to separate the red blood cells from the platelet-rich plasma. For plantar fasciitis, this plasma is then injected into the heel under the premise that platelets reduce inflammation and stimulate healing. Once patients have received the injection, they’re put on crutches for at least a week. Some patients report rapid pain relief, but that’s from spending time off of the sore heel, and not as a result of the injection they credit!
Athletes are receiving it for various sprains and injuries, but you never can seem to find any article on how the treatment actually works – because it doesn’t! PRP is being studied in clinical trials and has yet to show it promotes healing from injuries. Even the editor of The American Journal of Sports Medicine calls this nothing more than a “platelet-rich panacea.”
Doctors who offer PRP treatments perceive it as a relatively easy and harmless in-office procedure they can charge a lot of money for – in fact, on average, patients are charged upwards of $2,000 per treatment. Sadly, these doctors are jumping into PRP treatment headfirst.
The docs I personally know who are using PRP regularly aren’t very good at what they do, so this provides them the extra DB (doctor bling). Making matters worse is that large othoapaedic companies are pushing PRP more and more. It’s a real shame that the popularity of this treatment is seemingly driven more by office reps than evidence based medicine, which really pisses me off. More on evidence based medicine coming up soon.
Do not participate in this farce! When it comes to PRP, orthotics, injections, or soundwave “therapy,” they might appear safe and they usually are, but they don’t fix anything.
At least when it comes to the foot and ankle this is the plain fact: plantar fasciitis and many other foot problems are mechanical imbalances that lead to inflammation. Treat the mechanical problem and the inflammation will solve itself… which means the best thing you can do to prevent and relieve plantar fasciitis is also the simplest and most affordable. A proper regimen of stretching to maintain your flexibility is the only way to relieve your pain the right way and prevent heel pain.
Whatever Bart is taking, I hope there’s enough left over for the rest of the Yankee starters.
Well done article that. I’ll make sure to use it wliesy.
Great blog, what do you think of the FAST procedure that Bernie Morrey and Jimmy Andrews are pushing for these chronic calcific changes about the elbow, F & A, and knee?
(Ducks, pulls up chair and grabs beer!)
I admit I know just a bit about the FAST procedure. It does sound intriguing and makes more sense than cortisone and PRP. However I would still lump it into the gimmicky, quick fix/last domino type of treatment. Tendinitis does not arise magically; it comes about due to “imbalance” or overuse. So the key in my mind is to identify the activity, or more likely, the imbalance, the first domino to fall, if you will, and fix that if you really want to fix the problem. For example, plantar fasciitis is pain in the heel, right? But the origin of that pain, the first domino, is the calf that is too tight. While most of my colleagues focus on the “apparent” problem, I focus on the true problem, the calf. So, in any movement in the body from the simplest to the more complex, there is balance and that must be restored to really fix things like tendinitis, etc.
So in summary, I am not at all saying FAST does not work. I am just saying it is, in my opinion, misguided.
I have been to several orthopaedic surgeons and they only recommend surgery. They never mention stretches, physical therapy, pain medication, life style changes etc. It’s very frustrating. Surgery is scary and the recovery is long. This is why people are searching for alternatives.
Hi Laura,
You answer is going to be the next blog. Great question/comment. Keep an eye out.In the meantime start calf stretching.
Stay healthy my friends,
AO