Chronic plantar fasciitis is a common condition but can be difficult to successfully treat. Platelet rich plasma (PRP), a concentrated bioactive component of autologous blood rich in cytokines and other growth factors, was compared with cortisone injection in the treatment of severe cases of plantar fasciitis resistant to traditional non-operative paradigms. Thirty-six patients (16 males 20 females) were prospectively randomized into two study groups. All patients had pre-treatment MRI and ultrasound studies consistent with plantar fasciitis. The first group was treated with a single ultrasound guided injection of 40 mg Depo-Medrol at the injury site and the second group was treated with a single ultrasound guided injection of un-buffered autologous PRP at the injury site. The cortisone group had an average age of 59 (24–74) and had failed 4 months (3–24) of standard non-operative management (rest, heel lifts, PT, NSAIDS, cam walker immobilization, night splinting, local modalities) and had pre-treatment AOFAS scores of 52 (24–60). The PRP group had an average age of 51 (21–67) and had failed 5 months (3–26) of standard non-operative management (rest, heel lifts, PT, NSAIDS, cam walker immobilization, night splinting, local modalities) and had pre-treatment AOFAS scores of 37 (30–56). All patients were then immobilized fully weight bearing in a cam walker for 2 weeks, started on eccentric home exercises and allowed to return to normal activities as tolerated and without brace support. Post-treatment AOFAS scores were PRP 95 (84–100) and cortisone 81(60–90) at 3 months (CI 95% p< .0001), PRP 95 (86–100) and cortisone 81 (60–90) at 6 months (CI 95% p< .0001), and PRP 94 (86–100) and cortisone 58 (45–77) at 12 months (CI 95% p< .0001). Platelet rich plasma injection is more effective and durable than cortisone injection for the treatment of severe chronic plantar fasciitis refractory to traditional non-operative management

Microtenotomy coblation using a radiofrequency (RF) probe is a minimally invasive procedure for treating chronic tendinopathy. It has been described for conditions including tennis elbow and rotator cuff tendinitis. There have been no studies to show the effectiveness of such a procedure for plantar fasciitis. Fourteen patients with plantar fasciitis with failed conservative treatment underwent. TOPAZ RF treatment for their symptoms between 2007 and 2008. The RF-based microdebridement was performed using the TOPAZ Microdebrider device (ArthroCare, Sunnyvale, CA). They were followed-up for up to six months thereafter. Pre-operative, three and six months post-operative VAS, AOFAS ankle-hindfoot and SF-36 scores were analysed. There were six men and eight women, with an average age of 44.0 years (23–57). There were 15 feet, with six right and nine left feet. They were followed up for six months post-operatively. There was a significant improvement in mean pre-op and six-month VAS scores from 8.13 to 3.27(p=0.00), and AOFAS hindfoot scores from 34.37 to 71.33 (p=0.00). There was a significant decrease in SF-36 for bodily pain, and significant increases in physical and social function scores. Twelve out of 14 (85.7%) patients reported ‘good’ to ‘excellent’ satisfaction results at six months, and 11 out of 14 (78.6%) patients had their expectations met from the procedure at six months follow-up. TOPAZ RF coblation is a good and effective method for the treatment of plantar fasciitis. Early results are encouraging, and we believe that the pain experienced by the patients in the follow-ups will subsequently improve

Introduction. Although the majority of patients with plantar fasciitis respond to non- surgical management, between 5 and 10% of patients require surgical intervention. The aim of this study is to compare the results of open plantar fascia release with the results following a less invasive endoscopic release. Methods. A consecutive series of patients who underwent open plantar fascia release (group one) was compared to a similar group who underwent endoscopic plantar fascia release (group two). Each patient was assessed retrospectively using the American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Score. In addition, the patient's overall satisfaction with the procedure, time taken to return to full activity, and the complication rate was determined. Finally, pre- and post-operative radiographs were assessed for arch collapse in group two. Results. The demographics of the two groups were comparable. Group one contained 36 patients (38 ft) and group two contained 66 patients (70 ft). The mean follow up for both groups was 22 months. The mean AOFAS score for each group was comparable pre-operatively, however the post-operative score was significantly better for group two. The time taken to return to full activities was significantly quicker in the endoscopic group, and post-operative pain levels and satisfaction rates were also significantly better. Radiographs demonstrated no arch collapse in group two following the procedure. Conclusions. When surgery for plantar fasciitis is indicated, the results of this study have demonstrated an endoscopic approach offers a safe alternative to an open procedure. Furthermore, endoscopic release is associated with an accelerate activities and a higher patient satisfaction rate