Comparison of the effectiveness of platelet rich plasma and ozone therapy in plantar fasciitis treatment

Umit Yalcin


Background: Plantar fasciitis (PF) is one of the most common foot problems in adults. Conservative treatments are proportionally 90-95% successful. In this study, author aimed to compare the effectiveness of ozone therapy (OT) treatment of platelet rich plasma (PRP) injections in PF patients.

Methods: In the study, which was made prospectively, patients were randomly divided into two groups. In the first group (n=20), patients were injected with PRP in 3 sessions at a one week intervals, and in the second group (n=22) OT was injected in the same way. Each patient was evaluated with visual pain score before as well as 1 month after treatment in terms of pain, whereas the foot function index (FFI) was evaluated with the score in terms of functionality.

Results: In both groups, the 1st month VAS score and FFI score showed significant decrease (p<0.05) after treatment compared to before treatment. The decrease in VAS score and FFI score after treatment in the PRP group was significantly higher than the OT group (p˂0.05).

Conclusions: As a result of this study, authors found that both PRP and OT were beneficial in terms of pain and functional level in the treatment of PF, but in patients who underwent PRP, authors found that there was more statistical improvement in terms of both parameters than patients who received OT. In light of the absence of a previous publication comparing these two treatment options in PF treatment, this study contributes to the literature.


Complementary medicine, Plantar fasciitis, Pain, Platelet rich plasma, Ozone therapy

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Beyzadeoğlu T, Gokce A, Bekler H. The effectiveness of dorsiflexion night splint added to conservative treatmentn for plantar fasciitis. Acta Orthopaed Traumatolog Turc. 2007;41(3):220-4.

Özkut AT, Özkan NK, Uluçay Ç, Ertaş M and Eren A. Our results of extracorporeal shock wave lithotripsy in patients with persistent plantar fasciitis. Gozte Medi J. 2011;26(3):123-7.

League AC. Current Concepts Review: Plantar Fasciitis. Foot Ankle Int. 2008;29(3):358-66.

Sahin N, Ozturk A, Atici T. Foot mobility and plantar fascia elasticity in patients with plantar fasciitis. Acta Orthopaed Traumatolog Turc. 2011;44(5):385-91.

Toker S, Kılınçoğlu V, Güven M, Özkan NK, Gülcan E, Aksakallı E et al. Early and midterm results of calcaneal Spur (heel spur) treatment with local corticosteroid and anesthetic injection. Gözt Medi J. 2008;23(2):59-62.

Vural M, Biçer M, Ersoy S, Özhan G, Pekedis K. Evaluation of the Efficacy of Extracorporeal Shock Wave Therapy in Plantar Fasciitis. Bakirk Tip Magaz. 2013;9(2):64-8.

Pfeffer GB. Plantar heel pain. In: Baxter DE, eds. The Foot and Ankle in Sport. St. Louis: Mosby-Year Book; 1995: 195-206.

Tuna S. The effectiveness of extracorporeal shock wave therapy in patients with plantar fasciitis and its relationship with epin length. Dicle Medi J. 2014;41(2):337-40.

Gill LH. Plantar fasciitis: diagnosis and conservative management. J Am Acad Ortho Surg. 1997;5(2):109-517.

Gill LH, Kiebzak GM. Outcome of nonsurgical treatment for plantar fasciitis. Foot Ankle Internat. 1996;17(9):527-32.

Sánchez M, Anitua E, Orive G, Mujika I, Andia I. Platelet-rich therapies in the treatment of orthopaedic sport injuries. Sports Med. 2009;39(5):345-54.

Blue Cross and Blue Shield Association. Recombinant and autologous platelet-derived growth factors as a treatment of wound healing and other conditions. Curr Proced Terminol Am Medi Assoc. 2012.

Barrett SL, Erredge SE. Growth factors for chronic plantar fasciitis?. Podiatr Today. 2004;17(11):36-42.

de Vos RJ, van Veldhoven PL, Moen MH, Weir A, Tol JL, Maffulli N. Autologous growth factor injections in chronic tendinopathy: a systematic review. Br Med Bull. 2010;95:63-77.

Akşahin E, Doğruyol D, Yuksel HY, Hapa O, Doğan O, Celebi L, et al. The comparison of the effect of corticosteroids and platelet-rich plasma (PRP) for the treatment of plantar fasciitis. Arch Orthop Trauma Surg. 2012;132(6):781-5.

Martinelli N, Marinozzi A, Carni S, Trovato U, Bianchi A, Denaro V. Platelet-rich plasma injections for chronic plantar fasciitis. Int Orthop. 2013;37(5):839-42.

Anitua E. Plasma rich in growth factors: preliminary results of use in the preparation of future sites for implants. Int J Oral Maxillofac Implan. 1999;14(4):529-35.

Anitua E, Andia I, Ardanza B, Nurden P, Nurden AT. Autologous platelets as a source of proteins for healing and tissue regeneration. Thromb Haemost. 2004;91(1):4-15.

Maffulli N, Del Buono A. Platelet plasma rich products in musculoskeletal medicine: any evidence?. Surgeon. 2012;10(3):148-50.

Bocci VA. Scienti fi c and medical aspects of ozone therapy. State of the art. Arch Med Res. 2006;37(4):425-43.

Raeissadat SA, Tabibian E, Rayegani SM, Rahimi-Dehgolan S, Babaei-Ghazani A. An investigation into the ef fi cacy of intra-articular ozone (O2-O3) injection in patients with knee osteoarthritis: a systematic review and meta-analysis. J Pain Res. 2018;11:2537-50.

Raeissadat SA, Rayegani SM, Sadeghi F, Rahimi-Dehgolan S. Comparison of ozone and lidocaine injection ef fi cacy vs dry needling in myofascial pain syndrome patients. J Pain Res. 2018;11:1273-9.

Kavlak Y, Demirtaş RN. The effect of foot problems on foot functions in older men. Turk Geriatr Bull. 2010;13(3):191-6.

SooHoo NF, Intimate DB, Vyas RM, Botzler T. Evaluation of the validity of the Foot Function Index in measuring outcomes in patients with foot and ankle disorders. Foot Ankle Int. 2006;27(1):38-42.

Yaliman A, Sen EI, Eskiyurt N, Budiman-Mak E. Ayak Fonksiyon İndeksi’nin plantar fasiitli hastalarda Türkçe’ye çeviri ve adaptasyonu. Turk J Phys Med Rehab. 2014;60:212-22.

Wearing SC, Smeaters JE, Yates B. Sagittal Movement of the Medial Longitudinal Arch Is Unchanged in Plantar Fasciitis. Med Sci Sports Exerc. 2004;36(10):1761-7.

Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003;93(3):234-7.

Beyazova M, Gokce Sacred Y. Physical Med Rehabilitation. 2000:1067-70.

Yucel I, Yazici B, Degirmenci E, Erdogmus B, Dogan S. Comparison of ultrasound-, palpation-, and scintigraphy-guided steroid injections in the treatment of plantar fasciitis. Arch Orthopaed Trauma Surg. 2009 May 1;129(5):695.

Crawford F, Atkins D, Young P, Edwards J. Steroid injection for heel pain: evidence of short-term effectiveness. A randomized controlled trial. Rheumatology. 1999;38(10):974-7.

Sánchez M, Fiz N, Azofra J. A randomized clinical trial evaluating plasma rich in growth factors (PRGF Endoret) versus hyaluronicacid in the short-term treatment of symptomatic knee osteoarthritis. Arthroscopy. 2012;28(8):1070-8.

Guler O, Mutlu S, Isyar M. Comparison of short-term results of intraarticular platelet-rich plasma (PRP) and hyaluronic acidtreatments in early-stage gonarthrosis patients. Eur J Orthop Surg Traumatol. 2015;25(3):509-13.

Cerza F, Carnì S, Carcangiu A. Comparison between hyaluronic acid and platelet-rich plasma, intraarticular infiltration in the treatment of gonarthrosis. Am J Sports Med. 2012;40(12):2822-7.

Andia I, Sánchez M, Maffulli N. Joint pathology and platelet-rich plasma therapies. Expert Opin Biol Ther. 2012;12(1):7-22.

Bocci V. Oxygen-Ozone Therapy: A Critical Evaluation, 1st ed. Dordrecht: Springer Science + Business Media B.V; 2002.

Shallenberger F. Prolozone ™ –Regenerating Joints and Eliminating Pain. J Prolother. 2011;3(2):630-8.

Elvis AM, Ekta JS. Ozone therapy: A clinical review. J Nat Sci Biol Med. 2011;2(1):66-70.

Johansson E, Claesson R, van Dijken JW. Antibacterial effect of ozone on cariogenic bacterial species. J Dent. 2009;37(6):449-53.

Bahrami MH, Raeissadat SA, Barchinejad M, Elyaspour D, Rahimi-Dehgolan S. J Pain Res. 2019;24(12):2251-9.

Babaei-Ghazani A, Karimi N, Forogh B. Comparison of ultrasound-guided local ozone (O2-O3) injection vs corticosteroid injection in the treatment of chronic plantar fasciitis: a randomized clinical trial. Pain Med. 2019;20(2):314-22.