Sunday, January 16, 2011

Platelet Rich Plasma Therapy

I've had Plantar Fasciitis for awhile now. It started during my training for the 2009 NYC Marathon (4:19:26), and continued throughout 2010. After a failed attempt to restart my running in late 2010, I decided to get Platelet Rich Plasma Therapy on the advice of Dr. Metzl.

The idea is this: They extract blood from somewhere else in your body, put it in a centrifuge to concentrate the platelets, and then inject the platelet-rich portion of the extracted blood into the part that's broken. In my case, into my plantar fascia. Here are a couple of posts which describe the process in more detail:

I had the procedure done this past Thursday, the 13th at Dr. Metzl's office. He drew 50cc's of blood from my arm, and put it in the happy machine to spin for 15 minutes. The machine has two receptacles for syringes. The syringe with the drawn blood goes in the right (large) receptacle, and the platelet-rich plasma comes back out into a smaller syringe in the left receptacle. In my case, 50cc's of blood was good for 4cc's of platelet-rich plasma.

Once the centrifuge was done centrifuging, he got me ready for the injection. First, the nurse covered my foot in orange sterilizing gunk. Then Dr. Metzl started poking at it in various places, looking to see where the pain was worst. The place I indicated (the medial side of my foot, where the fascia joins the heel) is apparently the most common place for those with plantar fasciitis. I thought I was a unique and delicate flower. Apparently not. So anyway, that's where he planned to inject the platelet-rich plasma.

Now, I'm lying on my back. To make my experience as pain-free as possible (hahahaha), he gave my foot a blast of something cold to numb the skin, followed by an injection of some sort of anesthetic. The fun began shortly thereafter.

On the wall to my left was mounted the cover of the June 14, 2010 issue of New York magazine -- one of the Best Doctor issues (one imagines Dr. Metzl is in it). There was a poor little teddy bear on the cover. I remember this because that bear is what I stared at when Dr. Metzl stuck the needle in. It hurt. It hurt a lot. But only for about 15 seconds (which I assume means it only took 10). A deep, intense pain from well inside my foot. I'm surprised my gaze didn't burn a hole in the bear. After the injection was done, the nurse congratulated me for not swearing.

Assuming that this all works, and that I start running again (my goal is Harrisburg, PA in 2012), it'll all be worth it. Heck, it'll be worth it even if the "only" result is that I can get out of bed in the morning without pain in my foot.

After the procedure, I gingerly hobbled out of the office (no boot, no crutches -- just me and my own two feet), and headed home. It hurt for the rest of the day (no painkillers allowed, though apparently Tylenol is ok if absolutely necessary), was significantly better the next day (Friday), and by Sunday is largely back to where it was before I went in for the procedure.

Now, we wait a month. During that month, the doctor's orders are to "not be stupid". I think we've decided to use my wife's definition of stupid, rather than my own, as my own would likely result in all sorts of trouble. I'll probably head back to the gym on Tuesday for strength training, but I won't be doing anything that even remotely makes my fascia cranky. No jumping jacks, no stairs, no plank (so sad), no lunges. Upper body and abs only. After two weeks, I'll probably add swimming back in and some subset of pilates -- we'll have to see.


  1. HI Matthew,
    Just came across your blog while doing a Google search about PRP. I'm a runner -- have done 11 marathons-- and have been dealing with plantar fasciitis for the past 4 months or so. I have tried pretty much everything conservative one can try-- PT, stretching, orthotics, not running at all, the night split, etc. My doc just recommended PRP, but I'm wondering about your recovery and if you feel that it worked. I see this was posted over a year ago. Are you back to running regularly, and if so, when did that happen? Were you able to train for and run marathons? (or do you see that being a possibility?) I would really appreciate a response if you have some time. Thank you!

    1. The PRP made it so I could get out of bed flat-footed again, and that was a huge deal. It didn't cure it entirely. In order to make it manageable, I started massaging the heel of my foot religiously with a golf ball. That broke up whatever tightness was going on in there, and made it possible to run without it getting bad again. I found I had to keep using the golf ball to keep the really bad tightness from returning. There would still be tightness in the morning, but at a dull roar rather than a maybe-you-should-stop-running level.