Platelet-Rich Plasma Injections in Podiatric Practice
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When considering conservative treatment modalities for musculoskeletal (MSK) disorders in the foot and ankle, there are several options that can stimulate healing before having to resort to surgical intervention. A discussion of historic progression of extracorporeal shockwave therapy (ESWT) appeared in the May 2025 issue of Podiatry Today as an option with positive results in pain relief and support of tissue healing.1 Another emerging, less invasive modality is local injections of platelet-rich plasma (PRP). The mechanism by which PRP acts is via local infiltration of highly concentrated signaling molecules secreted by platelets, platelet-derived growth factors, vascular endothelial growth factors, fibroblast growth factor, insulin-like growth factors I and II, transforming growth factor beta, interleukin 8, and matrix metalloproteinases 2 and 9. This, in turn, leads to local inflammatory reactions, stem cell proliferation, cell adhesion, and angiogenesis.2
What Does the Research Currently Reveal?
Current literature has mixed views on PRP’s efficacy when used to treat Achilles tendon pathology. Most literature on PRP injections today involves elbows, Achilles tendons, and plantar fascia. In 2019, a meta-analysis of 5 randomized-control trials (RCTs) (total n=189) showed significant improvement in the Victorian Institute of Sport Assessment-Achilles (VISA-A) scale after 6 weeks, but not after 12 weeks, 24 weeks, or 1 year, when comparing placebo injection to PRP injection in chronic Achilles tendinopathy.3 Two studies within the meta-analysis also assessed visual analog scale (VAS) scores and tendon thickness, which noted improvement at the twelfth week.3 Whereas, another meta-analysis in 2021 of 11 RCTs (total n=574) reviewed PRP injection use on acute Achilles ruptures and chronic Achilles tendinopathy and found, when compared to the placebo control group, no significant evidence suggested improvement when looking at VISA-A scores as well as patient reported outcomes and clinical/functional outcomes.4
In comparison to the Achilles tendon, literature regarding treatment of plantar fasciitis (PF) using PRP shows a greater trend in favor of its use. A meta-analysis in 2017 of 9 RCTs (total n=416) looking at PRP vs PF steroid injections showed PRP exhibiting better VAS scores than the steroid treatment after 24 weeks, however, no significant differences in the Foot and Ankle Disability Index (FADI), American Orthopaedic Foot and Ankle Society (AOFAS), and Roles and Maudsley scores were observed between the 2 therapies (P>.05).5 A 2024 systematic review and meta-analysis with 21 RCTs (total n=1,356) compared PRP to corticosteroid injections, ESWT, and placebo, showing significantly improved VAS scores, (P=0.002, P=0.04, P<0.00001, respectively) and more effectiveness than the steroid injections and placebo in improving AOFAS scores. However, when assessing foot functional index (FFI), PRP did not demonstrate a significant advantage compared to ESWT, corticosteroid injection, dextrose prolotherapy, and meridian trigger points in enhancing foot functionality, except when compared to phonophoresis, where it showed a substantial improvement in FFI scores.6
Looking Ahead
As current literature available is sparse and conflicting, further research could provide more insight regarding its efficacy. Further studies regarding injection quantity and frequency are not well-described in current literature, and may prove useful toward this topic.4 Additional investigation may lead to new findings on new indications for PRP’s use in the field of podiatry.
Tavin B. Morgan, DPM, practices at Sierra Podiatry Center in Carson City, NV.
Anthony J. Popoff, DPM, practices at LECOM Health Institute for Successful Living in Erie, PA. He is the Clinical Assistant Professor of Podiatric Medicine and Surgery at LECOM School of Podiatric Medicine in Erie, PA.
References
1. Spector J. Thoughts on the Trajectory of ESWT in Podiatry. Podiatry Today. 2025;38(5)
2. Henning PR, Grear BJ. Platelet-rich plasma in the foot and ankle. Curr Rev Musculoskelet Med. 2018;11(4):616-623. doi:10.1007/s12178-018-9522-z
3. Liu CJ, Yu KL, Bai JB, Tian DH, Liu GL. Platelet-rich plasma injection for the treatment of chronic Achilles tendinopathy: A meta-analysis. Medicine (Baltimore). 2019;98(16):e15278. doi:10.1097/MD.0000000000015278
4. Chen J, Wan Y, Jiang H. The effect of platelet-rich plasma injection on chronic Achilles tendinopathy and acute Achilles tendon rupture. Platelets. 2022;33(3):339-349. doi:10.1080/09537104.2021.1961712
5. Yang WY, Han YH, Cao XW, et al. Platelet-rich plasma as a treatment for plantar fasciitis: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017;96(44):e8475. doi:10.1097/MD.0000000000008475
6. Herber A, Covarrubias O, Daher M, Tung WS, Gianakos AL. Platelet rich plasma therapy versus other modalities for treatment of plantar fasciitis: A systematic review and meta-analysis. Foot Ankle Surg. 2024;30(4):285-293. doi:10.1016/j.fas.2024.02.004
