PRP Injections for Foot & Ankle: Plantar Fasciitis, Achilles & More in Michigan

Medically reviewed by Dr. Tom Biernacki, DPM — Balance Foot & Ankle, Howell & Bloomfield Hills, MI

What Is PRP and How Does It Work for Foot Conditions?

Platelet-rich plasma (PRP) therapy uses concentrated growth factors derived from the patient’s own blood to stimulate tissue repair and regeneration. The procedure involves drawing a small amount of blood, centrifuging it to concentrate the platelets (which contain growth factors including PDGF, TGF-β, VEGF, and EGF), and injecting the concentrated platelet layer directly into damaged tissue. Unlike cortisone injections — which reduce inflammation but do not repair tissue — PRP is regenerative: it stimulates collagen synthesis, promotes angiogenesis (new blood vessel formation), and accelerates fibroblast migration into the damaged zone. In our Howell and Bloomfield Hills clinics, PRP is offered for conditions where the primary pathology is tendon degeneration or chronic fascial inflammation that has failed standard conservative care — particularly plantar fasciitis, Achilles tendinopathy, and partial tendon tears.

Conditions Best Suited for PRP in Podiatry

Chronic plantar fasciitis (failing cortisone, orthotics, and physical therapy after 4–6 months): PRP is the evidence-based second-line injection for plantar fasciitis. A 2020 systematic review and meta-analysis of 14 RCTs showed PRP superior to cortisone for plantar fasciitis pain at 6 and 12 months — with cortisone winning at 1 month (faster onset) but PRP showing more durable benefit. The key caveat: PRP for plantar fasciitis requires concurrent physical therapy and orthotic use to address the structural cause. Insertional Achilles tendinopathy: PRP injected under ultrasound guidance into the tendon-bone interface shows strong evidence for symptom reduction in patients who have failed eccentric loading protocols. Mid-substance Achilles tendinosis: moderate evidence, typically combined with the Alfredson eccentric exercise protocol. Posterior tibial tendon dysfunction (stage I–II): emerging evidence for PRP slowing tendon degeneration when combined with orthotics and physical therapy. Partial ligament tears: ankle lateral ligament complex partial tears unresponsive to conservative care.

The PRP Procedure: What to Expect

PRP is performed in-office and takes approximately 45–60 minutes total. Dr. Biernacki draws 30–60mL of blood from your arm (comparable to routine blood draw), processes it in a centrifuge for 15 minutes, confirms platelet concentration in the resulting PRP layer, and injects the PRP under ultrasound guidance into the target tissue. Ultrasound guidance is essential for accurate delivery — particularly for deep structures like the plantar fascia insertion and Achilles tendon where precise injection depth determines treatment effectiveness. The injection itself is performed after local anesthetic to the skin (the tendon/fascia injection itself produces moderate pressure rather than sharp pain in most patients). After the procedure, you should avoid NSAID medications (ibuprofen, naproxen) for 2–4 weeks — NSAIDs suppress the platelet-mediated inflammatory cascade that drives PRP’s regenerative effect.

Expected Timeline and How Many Injections Are Needed

PRP has a delayed onset of action compared to cortisone — most patients notice improvement beginning at 4–6 weeks and maximum benefit at 3–6 months. This timeline reflects the biological process of collagen synthesis and tissue remodeling rather than simple inflammation suppression. Most plantar fasciitis cases require 1–2 PRP injections. Achilles tendinopathy may require 2–3 injections spaced 4–6 weeks apart for severe or chronic cases. A structured rehabilitation protocol continues throughout the treatment period — PRP without rehabilitation has significantly lower success rates than PRP combined with progressive loading exercises.

PRP vs. Cortisone: How to Choose

The decision between PRP and cortisone depends on the condition, chronicity, patient goals, and timeline. Cortisone is preferred for: acute inflammatory flares requiring rapid pain relief, bursitis (retrocalcaneal, sub-metatarsal), gout attacks, and situations where the patient needs quick return to function. PRP is preferred for: chronic tendinopathy and fasciopathy that has failed cortisone (or received 2–3 prior injections), conditions where tissue regeneration is the therapeutic goal rather than inflammation suppression, and patients who want to avoid steroid side effects (fat pad atrophy risk from repeated plantar fascia cortisone, tendon weakening). Many patients receive initial cortisone for acute relief followed by PRP 4–6 weeks later to address the underlying degenerative tissue — this combination approach is used in our clinic for severe chronic plantar fasciitis.

Insurance Coverage for PRP in Michigan

PRP coverage varies significantly. As of 2026, most commercial insurance plans and Medicare consider PRP “investigational” for musculoskeletal conditions and do not cover it — PRP is typically a self-pay procedure. However, coverage is rapidly evolving as the evidence base grows; some BCBS Michigan plans have begun covering PRP for knee OA with specific criteria. The self-pay cost for one PRP injection at Balance Foot & Ankle is discussed at consultation. We offer payment plans. For patients with coverage uncertainty, we provide a letter of medical necessity for prior authorization submission. Call (810) 206-1402 to discuss costs and whether PRP is appropriate for your condition.

PRP Treatment at Balance Foot & Ankle Michigan

Dr. Tom Biernacki performs PRP injections under ultrasound guidance at our Howell (4330 E Grand River Ave) and Bloomfield Hills (43494 Woodward Ave #208) offices. PRP consultations are available same-day or next-day. Book online or call (810) 206-1402.

Frequently Asked Questions — PRP Injections