Platelet-rich plasma for foot and ankle disorders in the athletic population

Athletes and their physicians are constantly searching for ways to heal injuries faster and allow for a quicker return to activity and sport. However, reliable and effective means of treating foot and ankle tendon/ligament disorders as well as fracture nonunions, and osteochondral lesions of the talus are limited. In the past, rest/immobilization, corticosteroids/nonsteroidal anti-inflammatory drugs, and rehabilitation were the mainstays of nonoperative treatment. However, results were inconsistent. In addition, anti-inflammatory medications and corticosteroids have been associated with potentially serious side effects. Recently, platelet-rich plasma (PRP) has been heralded as a safe, new therapy with potential for treating both soft and mineralized tissue injuries throughout the body, including the foot and ankle. PRP is a concentrated solution of platelets and other buffy coat elements in plasma that can be activated by collagen or thrombin and calcium. Platelets are known to be rich in growth factors and cytokines that are involved in the healing response, such as platelet-derived growth factor, vascular endothelial growth factor, insulin-like growth factor-1, and transforming growth factor-β. Early reports showed positive results leading to increasingly greater interest. Currently, we recommend using PRP only for injuries/lesions of the foot and ankle that have failed standard therapies. Before use, a thorough history and physical examination should be performed, including a detailed history of allergies and blood disorders. For maximum benefit with minimal risk of complications, injections should be performed under image guidance. Despite the great potential associated with it, evidence regarding the efficacy of PRP has been primarily limited to small case series and anecdotal reports. More rigorous analyses, preferably randomized controlled studies, are needed before PRP may be adopted as a standard therapeutic modality.