Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Orthobiologics — biological substances derived from patients’ own blood, bone marrow, or adipose tissue that are processed and re-injected to stimulate healing — have gained significant clinical traction in foot and ankle medicine over the past decade. Platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and amnion-based products are increasingly used as adjuncts for chronic tendinopathy, ligament injuries, osteochondral defects, and non-union fractures. Understanding the evidence supporting each modality — and its limitations — guides rational use in clinical practice.

Platelet-Rich Plasma (PRP)

PRP is produced by centrifuging autologous whole blood to concentrate platelets 3–8× above baseline — along with the growth factors stored within platelet alpha granules: PDGF, TGF-β, VEGF, EGF, FGF, and IGF-1. These growth factors stimulate fibroblast proliferation, collagen synthesis, angiogenesis, and cell chemotaxis — the biological events required for tendon healing. PRP classification matters clinically: leukocyte-rich PRP (PRPL) contains white blood cells and has higher anti-inflammatory and antimicrobial properties; leukocyte-poor PRP (PPRP) has lower inflammatory cytokine content and may be preferred for intra-articular injection. For plantar fasciitis, two RCTs and multiple systematic reviews demonstrate PRP superior to corticosteroid injection at 6–12 months follow-up — corticosteroid provides faster initial relief, but PRP produces more durable outcomes at 6+ months. For Achilles tendinopathy, PRP evidence is more mixed — well-designed RCTs show benefit primarily for mid-portion tendinopathy when combined with loading programs.

Bone Marrow Aspirate Concentrate (BMAC)

BMAC contains mesenchymal stem cells (MSCs), growth factors, and hematopoietic progenitor cells harvested from the patient’s iliac crest or proximal tibia and concentrated by centrifugation. MSCs have the potential to differentiate into chondrocytes, tenocytes, and osteoblasts — making BMAC theoretically attractive for osteochondral defect management (OCD of the talus), non-union fractures, and cartilage defects. Published evidence for BMAC in talar OCD demonstrates significant improvement in cartilage fill and clinical outcomes at 2–5 year follow-up, with superior results compared to microfracture alone in lesions greater than 1.5 cm². For Achilles non-insertion calcific tendinopathy and chronic tendinopathy refractory to PRP, BMAC represents a second-tier orthobiologic intervention. The cost and procedural complexity of BMAC (iliac crest harvesting under sedation) limits its use to carefully selected cases.

Amnion-Based Products

Dehydrated human amnion/chorion membrane (dHACM) allografts contain growth factors, cytokines, and extracellular matrix components that modulate inflammation and stimulate healing without the inflammatory spike of PRP. dHACM has demonstrated efficacy in diabetic foot ulcers (wound closure superior to standard of care in RCTs), plantar fasciitis (two RCTs demonstrate superiority to corticosteroid at 6–12 weeks), and tendon augmentation. The non-cellular nature of amniotic products eliminates donor site morbidity and immune rejection concerns while providing a standardized growth factor concentration not achievable with autologous PRP.

Orthobiologic Injections at Balance Foot & Ankle

Dr. Biernacki at Balance Foot & Ankle offers PRP injection for plantar fasciitis, Achilles tendinopathy, and chronic foot and ankle tendinopathies that have failed conventional conservative management. PRP is prepared in-office from the patient’s own blood and injected under ultrasound guidance. Call (810) 206-1402 for a consultation on whether orthobiologic therapy is appropriate for your condition.

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Clinical References

1. Franceschi F, Papalia R, Franceschetti E, et al. Platelet-rich plasma injections for chronic plantar fasciopathy: a systematic review. Br Med Bull. 2014;112(1):83-95.
2. Grambart ST. Sports medicine and platelet-rich plasma: nonsurgical therapy. Clin Podiatr Med Surg. 2015;32(1):99-107.
3. Murawski CD, Kennedy JG. Percutaneous internal fixation of proximal fifth metatarsal jones fractures (zones II and III) with Charlotte Carolina screw and bone marrow aspirate concentrate: an outcome study in athletes. Am J Sports Med. 2011;39(6):1295-1301.

Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.