Orthobiologics in Foot and Ankle — PRP, Bone Marrow

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.

Chronic Tendon Pain? Ask About PRP Therapy.

Serving Southeast Michigan from Bloomfield Hills and Howell.

📞 (810) 206-1402 |

📧 Get Dr. Tom’s Free Lab Test Guide

Discover the 5 lab tests every person over 35 should ask their doctor about — explained in plain English by a board-certified physician.

Download Your Free Guide →

Book Online →

📍 Located in Michigan?

Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.

Book Now →
(810) 206-1402

In-Office Treatment at Balance Foot & Ankle

If home care isn’t resolving your your foot or ankle concern, a visit with a board-certified podiatrist is the fastest path to accurate diagnosis and a personalized plan. At Balance Foot & Ankle Specialists, Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin offer same-day and next-day appointments at both our Howell and Bloomfield Hills offices. We perform on-site diagnostic ultrasound, digital X-ray, conservative care, advanced regenerative treatments, and minimally invasive surgery when indicated.

Call (810) 206-1402 or request an appointment online. Most insurance plans accepted, including Medicare, Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare.

Most Common Mistake We See

The most common mistake we see is: Waiting too long before seeking care. Fix: any foot pain lasting more than 4 weeks, or any sudden severe symptom, deserves a professional evaluation rather than more rest.

Warning Signs That Need Same-Day Care

Frequently Asked Questions

When should I see a podiatrist?

If symptoms persist past 2 weeks, affect your normal activity, or are accompanied by red-flag symptoms (warmth, redness, swelling, inability to bear weight).

What does treatment cost?

Most diagnostic visits and conservative treatments are covered by Medicare and major insurers. Out-of-pocket costs vary by your specific plan.

How quickly can I get an appointment?

Most non-urgent cases see us within 5 business days. Urgent cases (sudden pain, possible fracture) typically same or next business day.