Thank you very much for the opportunity to show my audio poster successful use of plasma-rich protein to treat refractory chronic plantar fasciitis and Achilles tendonitis. I want to add my co-authors Emma Binns and Spencer Bach. Thank you for their help. I have no disclosures. Why did I start using PRP? Well, surgery for Achilles plantar fasciitis issues can be successful, but it has a high cost often requiring three to six months of post-surgery recovery time, limited weight-bearing physical therapy and time out of work. So I was trying to find an alternative for this issue and try to do non-surgical treatment for these patients for plantar fasciitis and these kind of common inflammatory issues of tendonitis and insertional tendonitis. Started in 2015. I was concerned about cash. We only charged $500 for an injection, but it still is cash. So I informed every patient about this. I followed patients closely for the first three to six months afterwards to make sure this was working because I didn't want to charge people for this if it wasn't going to work. And I maintained a patient database. Patients had either plantar fasciitis or Achilles tendonitis. Conservative treatment had been failed for at least six months. In several, in many cases, it was greater than a year. MRI was performed in all cases. To be a candidate, you had to show degenerative tendonitis or tendinosis in the Achilles or tendinitis or tendinosis changes in the fascia at the site of pain and tenderness. There was no, if there were no degenerative changes in the MRI, then the patient was not deemed a candidate for the PRP. And patients with purely mid-foot plantar fasciitis, I did not do surgery on those patients. All patients were deemed surgical candidates for this condition then, and of those patients, informed consent and discussion ensued about continued non-operative management surgery or PRP. The patients opted to proceed with PRP. This was a one-injection protocol. Informed consent was obtained. I drew the patient's blood myself. It was centrifuged per the protocol, PRP drawn off, local anesthetic injected just in the subcutaneous tissues, and then the PRP was injected into the tissue based on the anatomic landmarks without ultrasound guidance, but with knowledge of the pre-procedure MRI and the areas of degenerative change. Post-protocol, the post-injection, no NSAIDs or ice for three weeks. Ambulators tolerated moderate activities and continued home stretching. Plantar fasciitis patients had a post-op sandal for three to five days, and Achilles tendonitis patients had a boot for about three weeks and then going into a regular shoe. All patients were then assessed approximately six to eight weeks post-injection, and patients subject of improvement recorded. Longer-term data obtained through both patient return visits for something other than the index pathology or the index pathology after the eight-week follow-up and or patient telephone interviews. There were 110 PRP injections, 107 patients, but 16 patients were lost to follow-up, leaving 91 patients and 97 injections for analysis. 42 of 58 patients with Achilles issues reported greater than 50% relief of symptoms at six to eight weeks. 22 of 39 plantar fasciitis patients reported greater than 50% relief at six to eight weeks, leaving a total of 68% reporting greater than 58% improvement at six to eight weeks post-injection. Additional long-term results were then obtained. We couldn't reach 18 of the patients, but we were able to get a hold of 70 patients with 72 injections with average follow-up of greater than two years at 27 months. The Achilles tendonitis patients, 83% of the patients reported continued 50% relief of symptoms, and 89% of patients reported continued greater than 50% relief of symptoms. So greater than 85% of the patients reported had continued greater than 50% improvement at an average of greater than two years after the PRP injection and did not need surgery. And what we showed was that if patients did have positive results early, here's the Achilles tendon patients on the left, all these patients had greater than 50% relief, and you can see anywhere from 50 to 100. And most of these patients at the two-year time point actually had substantial improvement in their pain symptoms, upwards of 90 to 100%. We found the same results with plantar fasciitis, that if they improved early and were greater than 50%, then the vast majority of those actually moved up to the anywhere from 90 to 100% realm after that. So they oftentimes got better with time. The data was collected prospectively. However, the long-term data, there was not a long-term standard protocol for follow-up. There was no comparison arm for this study. So clearly we could do a comparison arm. 34 patients were lost to follow-up, and this could skew the results if one assumes all the patients did not improve. But if they did have some improvement and then did not return, that would skew the results the other way. So PRP is an effective alternative we found for patients with refractory plantar fasciitis and Achilles tendonitis that have failed non-operative measures and have MRI findings of degenerative tissue or fascia at the site of pain and tenderness. I think these findings contrast with other prospective studies because we actually studied just the patients who were refractory to non-operative treatments and face surgery rather than all patients who came into the clinic with that condition. Thank you very much.

plasma-rich protein

chronic plantar fasciitis

Achilles tendonitis

treatment

surgery alternative