الفهرس 
ANATOMYOnly 14 pages are availabe for public view
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Abstract
Heel pain is a common presenting complaint in the foot and ankle practice.
Plantar fasciitis (PF) is the most common cause of heel pain. It tends to occur more often in women, middle-aged, military recruits, athletes and the obese.
Approximately 10% of people suffer from PF at some point during their lifetime.
This condition is defined as traction degeneration of the plantar fascial band at its proximal attachment on the medial tubercle of the calcaneus.It is a non- inflammatory, degenerative condition associated with overuse. Its pathology is similar to a tendinosis or tendinopathy. Tendinosis is characterized by the absence of inflammatory cells, an abundance of disorganized collagen and fibroblastic hypertrophy, as well as disorganized vascular hyperplasia with avascular tendon fascicles.
The diagnosis of PF is based on clinical factors. Patients; typically compliant of pain around the area of the medial calcaneal tuberosity that; starts with the first step on arising in the morning or after prolonged sitting.
Corticosteroid injections are used for cases of PF refractory to conservative treatment and have been an effective modality for pain relief. However, the effect seems to be limited and short-lived. Also, a number of complications may occur the most serious of which are plantar fascial rupture and plantar fat pad atrophy. Fascial rupture interrupts the intrinsic windlass mechanism of the foot and can promote further inflammation in the surrounding tissue. In addition, plantar fat pad atrophy diminishes subcalcaneal cushioning, availing the plantar fascia to further insult and, hence, more pain.
Platelet-rich plasma (PRP) has been gaining popularity as a treatment for PF. Injection of PRP is thought to be safe, and not to interfere with the biomechanical function of the foot. It is a component of whole blood that is centrifuged to a concentrated state, treated with an activating agent, and injected into the affected area. The basic biologic mechanism of action of PRP is simple, after injection of PRP in an injured area, it induces a local inflammation. The pro-inflammatory mediators together with the growth factors released from the granules of the platelets trigger the localized inflammation and the wound healing cascade, resulting in the cellular migration and proliferation, glycosaminoglycan and collagen deposition, collagen maturation and remodeling of the healing tissue at different stages of wound healing. PRP therapy has been shown to improve pain scores and functional ability and to decrease plantar fascia thickness.
There is still controversy regarding the effectiveness of PRP injections compared with steroid injections in PF patients.
We carried out a randomized controlled trial on 376 patients (188 patients in PRP group and 188 patients is steroid group) with chronic plantar fasciitis after at least 3 months of complain and failure of conservative treatment. Follow-up duration was (1.5, 3&6 months) in most of these studies.
Steroid therapy effect appears in a short period (about 3 months post-injection), but PRP has a prolonged effect (for about 12 months post-injection).
A significant improvement in pain and foot function was found in the PRP group compared to the steroids group.
The PRP injection is better than steroid injection in relieving the pain of planar fasciitis and in improvement of the function of the patient foot.