Efficacy of platelet rich plasma in comparison to steroid for the management of chronic plantar fasciitis


  • Ankit Thora Department of Orthopaedics, Shalby Hospital, Indore, India
  • Anurag Tiwari Department of Orthopaedics, AIIMS Hospital, Bhopal, Madhya Pradesh, India
  • Nishit Bhatnagar Department of Orthopaedics, Maulana Azad Medical College, New Delhi, India
  • Mukul Mohindra Department of Orthopaedics, Safdarjung Hospital, Delhi, India




PRP, Steroid injection, Plantar fasciitis


Background: Chronic plantar fasciitis is often a difficult to treat entity and platelet-rich plasma (PRP) is an upcoming modality instead of steroid in chronic cases of plantar fasciitis resistant to traditional non-operative management.

Methods: Sixty patients with chronic plantar fasciitis were prospectively randomised into 2 groups and treated with either a single injection of 3 cc PRP or 40 mg DepoMedrol (Cortisone) injection and followed for a year. Immediately prior to PRP or cortisone injection American Orthopedic Foot and Ankle Society (AOFAS) hind foot scoring was done for all patients. These scores were repeated at 6 weeks, 6 months and 12 months.

Results: Six weeks evaluation of AOFAS after PRP and corticosteroid administration, the mean visual analogue scale (VAS Score) showed a significant increase in corticosteroid group (4.2) as compared to PRP group (5.8). But, the PRP group (1.8) showed significant improvement in mean VAS scores as compared to Steroid group (3.4) after a year of the treatment. Similarly, the AOFAS score improved significantly in the steroid group (64.4) at 6wks as compared to the PRP group (52.2) but at 12 months however, the PRP group sustained its effect with a mean AOFAS score of 92.2 while in the steroid group, the score dropped to a mean of 78.4.

Conclusions: PRP was more effective than steroid for the long term treatment of chronic plantar fasciitis. Level of Evidence: Level I, prospective randomized comparative series.


Riddle DL, Pulsic M, Pidcoe P, Johnson RE. Risk factors for plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. 2003;85:872-7.

Astrom M, Rausing A. Chronic Achilles tendonopathy: a survey of surgical and histopathological findings. Clin Orthop Relat Res. 1995;316:151-64.

Kajikawa Y, Morihara T, Sakamoto H, Matsuda K, Oshima Y, Yoshida A, et al. Platelet-rich plasma enhances the initial mobilization of circulation derived cells for tendon healing. J Cell Physiol. 2008;215:837-45.

Lyras DN, Kazakos K, Verettas D, Polychronidis A, Tryfonidis M, Botaitis S, et al. The influence of platelet rich plasma on angiogenesis during the early phase of tendon healing. Foot Ankle Int. 2009;30:1101-6.

Toomey EP. Plantar heel pain. Foot Ankle Clin. 2009;14:229-45.

Cheung JT, An KN, Zhang M. Consequences of partial and total plantar fascial release: a finite element study. Foot Ankle Int. 2006;27:125-32.

Barrett S, Erredge S. Growth factors for chronic plantar fasciitis. Podiatry Today. 2004;17:37-42.

Dorotka R, Sabeti M, Jimenez-Boj E, Goll A, Schubert S, Trieb K, et al. Location of modalities for focused extracorporeal shock wave application in the treatment of chronic plantar fasciitis. Foot Ankle Int. 2006;27:943-7.

Lee TG, Ahmad TS. Intralesional autologous blood injection compared to cortisone injection for treatment of chronic plantar fasciitis. A prospective randomized controlled trial. Foot Ankle Int. 2007;28:984-90.

Maley DS, Pressman M, Assili A, Kline JT, York S, Buren B, et al. Extracorporeal shockwave therapy versus placebo for the treatment of chronic proximal plantar fasciitis: results of a randomized placebo controlled double blinded multicenter intervention trial. J Foot Ankle Surg. 2006;45:196-210.

Tsai WC, Hsu CC, Chen CP, Chen MJ, Yu TY, Chen YJ. Plantar fasciitis treated with local steroid injection: comparison between sonographic and palpation guidance. J Clin Ultrasound. 2006;34:12-6.

Hall MP, Brand PA, Meislin RJ, Jazrawi LM, Cardone DA. Platelet-rich plasma: current concepts and application in sports medicine. J Am Acad Orthop Surg. 2009;17:602-9.

Anitua E, Andia I, Sanchez M, Azofra J, del Mar Zalduendo M, de la Fuente M, et al. Autologous preparations rich in growth factors promote proliferation and induce VEGF and HGF production by human tendon cells in culture. J Orthop Res. 2005;23:281-6.

Anitua E, Sanchez M, Nurden AT, Zalduendo M, de la Fuente M, Azofra J, et al. Reciprocal actions of platelet-secreted TGF-beta 1 on the production of VEGF and HGF by human tendon cells. Plast Reconstr Surg. 2007;119:950-9.

Shen W, Li Y, Zhu J, Huard J. Interaction between macrophages, TGF-beta 1, and the Cox-2 pathway during inflammatory pathway phase of skeletal muscle healing after muscle injury. J Cell Physol. 2008;214:405-12.

Tiwari M, Bhargava R. Platelet rich plasma therapy: A comparative effective therapy with promising results in plantar fasciitis. J Clinl Orthop Trauma. 2013;4(1):31-5.

Akashin E, Dogruyol D, Yuksel HY, et al. The comparison of the effect of corticosteroids and platelet-rich plasma (PRP) for the treatment of plantar fasciitis. Arch Orthop Trauma Surg. 2012;132:781-5.

Mishra A, Pavelko T. Treatment of chronic elbow tendonosis with buffered platelet rich plasma. Am J Sports Med. 2006;34:1774-8.

Ragab EM, Othman AM. Platelet rich plasma for treatment of chronic plantar fasciitis. Arch Orthop Trauma Surg. 2012;132:1065-70.

Jain K, Murphy PN, Clough TM. Platelet rich plasma versus corticosteroid injection for plantar fasciitis: A comparative study. Foot (Edinb). 2015;25(4):235-7.

Shetty VD, Dhillon M, Hegde C, Jagtap P, Shetty S. A study to compare the efficacy of corticosteroid therapy with platelet-rich plasma therapy in recalcitrant plantar fasciitis: a preliminary report. Foot Ankle Surg. 2014;20(1):10-3.

Say F, Gürler D, İnkaya E, Bülbül M. Comparison of platelet-rich plasma and steroid injection in the treatment of plantar fasciitis. Acta Orthop Traumatol Turc. 2014;48(6):667-72.

Martinelli N, Marinozzi A, Carnì S, Trovato U, Bianchi A, Denaro V. Platelet-rich plasma injections for chronic plantar fasciitis. Int Orthop. 2013;37:839-42.

Singh P, Madanipour S, Bhamra JS, Gill I. A systematic review and meta-analysis of platelet-rich plasma versus corticosteroid injections for plantar fasciopathy. Int Orthop. 2017;41(6):1169-81.

Lee TG, Ahmad TS. Intralesional autologous blood injection compared to cortisone injection for treatment of chronic plantar fasciitis. A prospective randomized controlled trial. Foot Ankle Int. 2007;28:984-90.

Lopez-Gavito E, Gomez-Carlin LA, Parra-Tellez P. Platelet-rich plasma for managing calcaneus tendon tendinopathy and plantar fasciitis. Acta Ortop Mex. 2011;25:380-5.






Original Research Articles