The Sports Docs Podcast
Sports medicine is a constantly evolving field, with hundreds of new articles published each month on the topic. This ever-growing wealth of information can make it challenging to stay updated on the newest approaches and techniques, and to know which data should actually change your practice. Join orthopedic surgeons, Dr. Catherine Logan and Dr. Ashley Bassett, as they chat about the most recent developments in sports medicine and dissect through all the noise.
On each episode of The Sports Docs podcast, the hosts will tackle a specific injury – from ACL tears to shoulder instability – and review the top research from various high-impact journals that month, including The American Journal of Sports Medicine, Arthroscopy: The Journal of Arthroscopic and Related Surgery, Sports Health, Journal of Shoulder and Elbow Surgeons, and more. The Sports Docs will also be joined by experts in the field of sports medicine – orthopedic surgeons, nonoperative sports medicine specialists, athletes, physical therapists, athletic trainers and others – to provide a fresh and well-rounded perspective based on their unique experiences.
The Sports Docs – Dr. Logan & Dr. Bassett – are friends & former co-residents from the Harvard Combined Orthopaedic Residency Program, who went onto esteemed sports medicine fellowships at The Steadman Clinic and The Rothman Institute, respectively. Dr. Logan practices in Denver, CO, and serves as Team Physician for Men's USA Lacrosse & as a Team Physician for U.S. Ski & Snowboard. Dr. Bassett is the director of the Women’s Sports Medicine Center at the Orthopedic Institute of New Jersey and practices across northern NJ, primarily in Morris and Sussex Counties.
Together, they will bring monthly conversations on how to care for athletes of all ages and levels of play, with a healthy mix of cutting-edge science and real-world application.
The Sports Docs Podcast
180: Dr. Arianna Gianakos – Plantar Fasciitis in Athletes (Part II)
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🎧 Episode Summary
In Part II of our discussion on plantar fasciitis, Dr. Ashley Bassett and Dr. Catherine Logan continue their conversation with Dr. Arianna Gianakos, orthopedic foot and ankle surgeon at Yale University. This episode focuses on treatment options for patients who fail initial conservative management, including injection therapies, biologics, and surgical intervention for recalcitrant plantar fasciitis.
The discussion highlights the latest evidence supporting platelet-rich plasma (PRP), compares PRP to corticosteroid injections and other nonoperative treatments, and reviews emerging minimally invasive surgical techniques—including nano-arthroscopic plantar fascia release.
Highlights
Platelet-Rich Plasma (PRP) for Plantar Fasciitis
Recent evidence continues to support the use of PRP for chronic plantar fasciitis.
Key findings from a 2024 Level I systematic review and meta-analysis:
- PRP resulted in significantly greater pain reduction compared to:
- Corticosteroid injections
- Extracorporeal shockwave therapy (ESWT)
- Placebo injections
- PRP demonstrated improved functional outcomes as measured by AOFAS scores.
- Benefits were most apparent in patients with chronic, recalcitrant symptoms.
PRP vs Corticosteroid Injections
Corticosteroid Injections
Advantages:
- Rapid short-term pain relief
- Widely available
- Low cost
Limitations:
- Effects are often temporary
- Higher recurrence rates
- Potential risks include:
- Plantar fascia rupture
- Fat pad atrophy
- Tissue degeneration with repeated injections
PRP
Advantages:
- Targets the underlying degenerative process
- Encourages tissue healing and remodeling
- More durable symptom relief
- Improved long-term outcomes compared with corticosteroids
Challenges:
- Higher cost
- Lack of standardization in preparation techniques
- Variability in platelet concentration and leukocyte content
The Role of Biologics
A key theme throughout the discussion is that biologics should be viewed as tools to optimize healing rather than miracle cures.
Important considerations include:
- Appropriate patient selection
- Chronicity of symptoms
- Failure of structured conservative treatment
- Realistic expectations regarding recovery timelines
When Is Surgery Appropriate?
Fortunately, most patients improve without surgery.
Surgical intervention may be considered when:
- Symptoms persist for 6–12 months or longer
- Conservative treatments have been exhausted
- Pain continues to significantly limit daily activities, exercise, or athletic participation
Before surgery, patients should typically complete:
- Stretching and strengthening programs
- Orthotic management
- Night splints
- Physical therapy
- Injection-based treatments when appropriate
Nano-Arthroscopic Plantar Fascia Release
The episode concludes with a discussion of a novel nano-arthroscopic plantar fascia release technique recently described in Arthroscopy Techniques.
Potential advantages include:
- Single-portal minimally invasive approach
- Reduced soft tissue disruption
- Less postoperative pain
- Reduced neurovascular risk
- Earlier weightbearing
- Faster return to daily activities and sport
Surgical Pearls
When performing plantar fascia release:
- Partial release is preferred over complete release.
- Over-release can alter foot biomechanics and increase lateral column pain.
- Careful patient selection remains critical.
- Surgery should be reserved for truly recalcitrant cases.
Key Takeaways
- PRP demonstrates superior pain relief and functional outcomes compared to corticosteroid injections and placebo in chronic plantar fasciitis.
- Corticosteroids may provide short-term symptom relief but do not address the underlying degenerative pathology.
- Most patients improve with nonoperative management and never require surgery.
- Surgical treatment should be reserved for patients who fail a comprehensive course of conservative care.
- Nano-arthroscopic plantar fascia release represents an exciting minimally invasive option that may reduce pain, soft tissue injury, and recovery time.
- Appropriate patient selection and realistic expectations remain essential regardless of treatment choice.
Featured Guest
Dr. Arianna Gianakos – Orthopedic Foot & Ankle Surgeon, Yale University; specialist in sports-related foot and ankle injuries, cartilage restoration, and advanced foot and ankle reconstruction.
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Our Hosts:
Ashley Bassett, MD & Catherine Logan, MD, MBA / www.cosportsmedicine.com
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