Outcome Analysis of Leukocyte-Rich Platelet-Rich Plasma, Leukocyte-Poor Platelet-Rich Plasma, and Injectable Platelet-Rich Fibrin in the Management of Chronic Plantar Fasciitis: A Prospective Comparative Study

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Abstract

Introduction: Plantar heel pain is the most frequent type of plantar pain in adults. The cellular composition of the platelet concentrates used (leukocyte-rich platelet-rich plasma [LR-PRP], leukocyte-poor PRP [LP-PRP], and injectable platelet-rich fibrin [iPRF]) as well as the kinetics of their growth-factor release differ; however, there is no head-to-head evidence thus far for plantar fasciitis (PF) treatment. We aim to assess pain relief, functional results, and plantar fascia thickness in patients with chronic PF treated with LR-PRP, LP-PRP, or iPRF. Materials and Methods: A prospective single-center comparative study identified 57 adults (aged 30–60 years) who had chronic PF that failed to respond to ≥3 months of conservative treatment. Patients were randomly assigned to LR-PRP (n = 19), LP-PRP (n = 20), or iPRF (n = 18) and received a single injection using the peppering technique of 3 mL. At baseline, 1, 3, and 6 months, the Visual Analog Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, and ultrasonographic plantar fascia thickness were recorded. Results: At each follow-up, there were significant improvements in VAS and AOFAS in all three preparations (P < 0.05). At 6 months, the mean VAS fell from 7.66 to 2.25 (LR-PRP), from 7.33 to 2.10 (LP-PRP), and from 7.69 to 2.09 (iPRF), whereas AOFAS rose from 49.55 to 82.64, from 55.24 to 85.43, and from 53.17 to 90.79, respectively. No major adverse events occurred, and iPRF had the highest mean ΔAOFAS (37.6) and the lowest residual VAS score. Conclusion: LR-PRP, LP-PRP, and iPRF are effective and safe injectable biologics for chronic PF, with iPRF being the only preparation that does not contain anticoagulants and where the growth factors are released over time, showing a slight but consistent functional benefit at 6 months. Keywords: Plantar fasciitis, platelet-rich plasma, injectable platelet-rich fibrin, leukocyte-rich platelet-rich plasma, leukocyte-poor platelet-rich plasma, regenerative medicine.