| Condition | Evidence Level | Protocol | Success Rate | vs Corticosteroid |
|---|---|---|---|---|
| Plantar Fasciitis (Chronic) | Level I — multiple RCTs vs corticosteroid | 1–2 US-guided injections at fascia origin; 3–6 weeks apart | 70–80% significant improvement at 6 months; durable at 12 months | Superior to corticosteroid at 6–12 months; slower onset (4–6 weeks) |
| Achilles Tendinopathy | Level II — multiple RCTs; mixed results | 2–3 peritendinous US-guided injections; combined with eccentric loading protocol | 60–75% improvement; best for mid-tendon tendinopathy | Superior to saline; mixed vs corticosteroid (corticosteroid faster, PRP more durable) |
| Lateral Ankle Ligament (Chronic Instability) | Level III | 1–2 periligamentous injections; adjunct to PT | 50–65% improvement as adjunct | Emerging; not standard of care yet |
| Ankle Osteoarthritis | Level II | 1–3 intra-articular injections; 4–6 weeks apart | 55–70% pain reduction; 6–12 months duration | Comparable to hyaluronic acid; superior to saline; inferior to corticosteroid short-term but more durable |
| Postoperative Healing Augmentation | Level II — tendon repair, OAT, subtalar fusion | Applied at surgical site intraoperatively | Improved healing rates in tendon repair; faster bone healing in fusion augmentation | Adjunct to surgery; not standalone |
| PRP Characteristic | Leukocyte-Rich PRP (LR-PRP) | Leukocyte-Poor PRP (LP-PRP) | Clinical Application |
|---|---|---|---|
| WBC Content | High — pro-inflammatory cytokines included | Low — primarily platelets and growth factors | LR-PRP: tendinopathy; LP-PRP: joint/cartilage |
| Platelet Concentration | 4–8× baseline | 3–6× baseline | Both acceptable; concentration alone not predictive of outcome |
| Growth Factors | PDGF, TGF-β1, VEGF, EGF, bFGF — all present | Same; without pro-inflammatory WBC effect | Both stimulate angiogenesis, collagen synthesis, cell proliferation |
| Best Use | Tendinopathy (plantar fasciitis, Achilles); stimulates tendon remodeling | Intra-articular (ankle OA, cartilage); avoids synovial inflammation | Preparation type affects outcomes — LP-PRP preferred for joints |
| Preparation Method | Single-spin centrifugation | Double-spin centrifugation | Different centrifugation protocols produce clinically different products |
PRP injections accelerate tendon and ligament healing — here is when it works and when it does not.
You are in the right place. Dr. Tom Biernacki, DPM, FACFAS — board-certified foot & ankle surgeon with 3,000+ surgeries — explains exactly what platelet-rich plasma (PRP) for foot and ankle means and what works. Call (810) 206-1402 for same-day appointment at Howell or Bloomfield Hills.
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Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
Quick Answer:
Quick Answer: Platelet-rich plasma (PRP) therapy uses concentrated growth factors from your own blood to stimulate healing in chronic tendon and soft tissue injuries. Dr. Biernacki at Balance Foot & Ankle offers PRP injections for plantar fasciitis, Achilles tendinopathy, and ankle ligament injuries in Howell, Michigan. Results vary and Dr. Biernacki provides honest evidence-based guidance on candidacy.
Platelet-rich plasma (PRP) therapy has generated significant interest as a regenerative treatment for chronic foot and ankle conditions—particularly plantar fasciitis and Achilles tendinopathy. By concentrating growth factors from a patient’s own blood and injecting them into the site of injury, PRP aims to stimulate a healing response in tissue that has failed to self-repair. At Balance Foot & Ankle, Dr. Tom Biernacki provides PRP therapy with honest, evidence-based counseling about what this treatment can—and cannot—reliably accomplish for Michigan patients.
What Is PRP Therapy?
PRP is produced by drawing a small volume of the patient’s blood (typically 15–30 mL), then centrifuging it to separate and concentrate the platelet-rich layer. This concentrate contains growth factors including PDGF, TGF-β, VEGF, and EGF—signaling molecules that activate fibroblasts, tenocytes, and stem cells involved in tissue repair. The PRP is then injected—often under ultrasound guidance—directly into the target tissue: the plantar fascia, Achilles tendon insertion, or ankle ligament. No donor tissue or synthetic materials are involved, making PRP a low-allergy, minimally invasive treatment option.
Conditions PRP May Help
Plantar fasciitis: Multiple randomized controlled trials demonstrate PRP provides superior long-term pain relief compared to corticosteroid injection at 3–6 month follow-up, though corticosteroid injections have faster initial response. PRP is particularly valuable for patients who have failed steroid injections or in whom steroid use is contraindicated. Insertional Achilles tendinopathy: Chronic insertional Achilles tendinopathy with calcification often responds poorly to eccentric exercise and steroid injections. PRP shows promise as an adjunct to physical therapy in this difficult-to-treat condition. Non-insertional Achilles tendinopathy: Evidence supports PRP as an alternative when conservative measures fail. Ankle ligament injuries: Emerging evidence supports PRP for chronic lateral ankle instability augmenting Broström repair and for syndesmotic injuries.
What PRP Is Not
PRP is not a guaranteed cure and is not appropriate for all patients. Patients with acute injuries that simply need time and standard rehabilitation, those with structural tears requiring surgical repair, or patients with bleeding disorders, active infection, or platelet dysfunction are not candidates. PRP is also not a substitute for weight loss, footwear modification, physical therapy, or orthotics in chronic plantar fasciitis. Dr. Biernacki emphasizes that PRP works best as part of a comprehensive treatment strategy, not as a standalone rescue injection.
The PRP Procedure at Balance Foot & Ankle
The PRP procedure takes approximately 45–60 minutes in the office. Blood is drawn, centrifuged, and the PRP layer is separated and activated. Under ultrasound guidance (preferred for accuracy), the PRP is injected into the target structure. A period of relative rest—typically 1–2 weeks of reduced activity—follows the injection, as the healing response involves initial inflammation. Physical therapy should be integrated into the post-PRP protocol to capitalize on the healing window. Most patients require one injection; some chronic conditions may benefit from a series of 2–3 injections spaced 4–6 weeks apart.
Cost and Insurance Coverage
PRP injections are generally not covered by insurance as they are considered experimental or investigational for most musculoskeletal conditions. Out-of-pocket costs vary based on preparation protocol and provider. Dr. Biernacki provides transparent pricing during consultation and helps patients weigh the evidence and cost-benefit before proceeding. For many patients with chronic plantar fasciitis or Achilles tendinopathy who have exhausted conservative options, PRP represents a meaningful step before considering surgical intervention.
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✅ Pros / Benefits
- Autologous (your own blood) treatment—essentially zero allergy or rejection risk
- Evidence supports superior long-term outcomes vs. corticosteroid for plantar fasciitis at 3–6 months
- Valuable option for patients who failed steroid injections or have contraindications to steroids
❌ Cons / Risks
- Not covered by most insurance—significant out-of-pocket cost requiring patient commitment
- Not appropriate for all patients—structural tears, acute injuries, and poor candidates may not benefit
- Temporary increase in pain and inflammation for 1–2 weeks post-injection is expected and uncomfortable
Dr. Tom Biernacki’s Recommendation
I appreciate PRP for what it is: a biologically rational, evidence-supported treatment option for specific chronic tendon conditions that have failed standard conservative care. What I don’t appreciate is the hype that sometimes surrounds it as a cure-all. When I’m counseling patients about PRP, I’m honest about the evidence—it’s solid for plantar fasciitis and insertional Achilles, it’s promising but less definitive for other conditions. I also make clear that PRP is not a substitute for addressing the underlying biomechanical problems—orthotics, physical therapy, weight management. The patients who do best combine PRP with a complete treatment strategy.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
How many PRP injections do I need for plantar fasciitis?
Most plantar fasciitis cases respond to a single PRP injection combined with physical therapy and orthotic support. Chronic cases with prolonged symptoms or those with incomplete response to the first injection may benefit from a second injection at 6–8 weeks. Dr. Biernacki reassesses at 6–8 weeks post-injection to determine whether additional treatment is warranted based on clinical response.
Does PRP hurt more than a cortisone injection?
The injection itself is comparable in discomfort—both involve a needle into a sensitized tendon. However, PRP’s post-injection inflammatory response (part of the healing mechanism) causes more soreness for 1–2 weeks than cortisone, which provides rapid anti-inflammatory relief. Patients should plan for relative rest during this window rather than expecting immediate pain reduction as with cortisone.
Can I get PRP for Achilles tendinopathy at Balance Foot & Ankle?
Yes. Dr. Biernacki provides PRP for both insertional and non-insertional Achilles tendinopathy. Insertional Achilles tendinopathy—particularly with calcification—is one of the most compelling indications for PRP given the poor response to corticosteroid injections at this location and the meaningful evidence supporting PRP in chronic insertional disease.
Is PRP better than surgery for plantar fasciitis?
PRP is not a surgical treatment—it’s a conservative option that aims to avoid surgery. For appropriate patients (chronic plantar fasciitis, failed conservative care including physical therapy and orthotics), PRP is a reasonable step before considering surgical plantar fascia release. Not all patients who receive PRP avoid surgery, but many achieve sufficient relief that surgery becomes unnecessary.
Michigan Foot Pain? See Dr. Biernacki In Person
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📞 (810) 206-1402 Book Online →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.
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.
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)