The current standard for local injection therapies includes corticosteroid injections, however, many patients only experience partial improvement and the benefits tend to diminish over time. In recent years, platelet-rich plasma (PRP) injections have gained prominence in the treatment of plantar fasciitis by leveraging the regenerative potential of platelets and leukocytes leukocytes [Molloy et al, 2003].

The efficacy of PRP versus corticosteroid treatment for plantar fasciitis remains controversial, as various randomized controlled trials (RCTs) have yielded conflicting results. A recent systematic review and meta-analysis comparing PRP to corticosteroids hopes to clarify the confusion and help determine if one treatment is superior for managing pain and improving foot function in patients with plantar fasciitis.

What Are PRP and Corticosteroids?

The current standard for injections for plantar fasciitis includes corticosteroid injections. Corticosteroids are powerful medications used to reduce inflammation and provide short-term pain relief. They're injected directly into the affected area and work quickly, which provide short-term pain relief in approximately 70-80% of patients, but their effects tend to wear off after a few months with the pain relief generally last only between 4 to 12 weeks. The greatest relief tends to be observed around 4 weeks post-injection [Speed, 2007; McMillan et al, 2012; Whittaker et al, 2019; David et al, 2017].

PRP is a treatment made from a patient’s own blood. After being processed, the blood is rich in growth factors that help the body heal by promoting tissue repair. Unlike corticosteroids, PRP focuses on rebuilding the damaged tissue, not just relieving pain.

This study identified 24 randomized controlled trials comparing PRP and corticosteroid injections for the treatment of plantar fasciitis. The authors performed a meta-analysis and found that that, compared to corticosteroid injections, local injections of PRP provided better relief from pain and improvement in foot and ankle function at 3 to 6 months.

This Study’s Key Findings Are:

• Pain Relief: At 1-month after the injections In both PRP and corticosteroids were helpful for pain suggesting a similar short-term benefit, however, at 3 to 6 months after the injection those patients treated with PRP reported significantly less pain than those who received corticosteroids.
  
• Foot Function: Foot function was measured using a special functional score. PRP performed better at improving overall foot movement and ability at 3, 6, and even 12 months after the injection.
• Safety: Corticosteroids can sometimes cause side effects like tissue thinning or even a tear in the plantar fascia. The authors found that PRP has fewer risks, but the injection can cause some short-term pain.

Why Does PRP Work So Well Over Time?

Plantar fasciitis pain is not due to inflammation, but is caused by repetitive microtrauma and excessive tension on the plantar fascia, which leads to microtears within the fascia [Thompson et al, 2014]. These microtears result in swelling, edema and degenerative changes, which cause structural damage and pain in patients with plantar fasciitis.

Corticosteroids treat inflammation, which is why they workquickly. PRP, on the other hand releases a concentrated array of growth factors, which are pivotal in tissue repair and regeneration, which takes time but leads to longer-lasting results [Hall et al, 2009].

What Does This Mean for Patients?

Based on this recent systematic review and meta-analysis, PRP "is a promising therapeutic option, particularly for patients who have not responded adequately to conventional treatments treatments." PRP appears to offer better results over the long-term without the risks linked to repeated corticosteroid injections.

Conclusions

While both treatments can help, PRP has the ability to improve pain and function in the long term.

References

1. David JA, Sankarapandian V, Christopher PR, Chatterjee A, Macaden AS. Injected corticosteroids for treating plantar heel pain in adults. Cochrane Database Syst Rev. 2017 Jun 11;6(6):CD009348.
2. Hall MP, Band PA, Meislin RJ, Jazrawi LM, Cardone DA. Platelet-rich plasma: current concepts and application in sports medicine. J Am Acad Orthop Surg. 2009 Oct;17(10):602-8.
3. McMillan AM, Landorf KB, Gilheany MF, Bird AR, Morrow AD, Menz HB. Ultrasound guided corticosteroid injection for plantar fasciitis: randomised controlled trial. BMJ. 2012 May 22;344:e3260.
4. Molloy T, Wang Y, Murrell G. The roles of growth factors in tendon and ligament healing. Sports Med. 2003;33(5):381-94.
5. Orchard J. Plantar fasciitis. BMJ. 2012 Oct 10;345:e6603.
6. Speed CA. Injection therapies for soft-tissue lesions. Best Pract Res Clin Rheumatol. 2007 Apr;21(2):333-47.
7. Whittaker GA, Landorf KB, Munteanu SE, Menz HB. Predictors of response to foot orthoses and corticosteroid injection for plantar heel pain. J Foot Ankle Res. 2020 Sep 29;13(1):60.
8. Zuo A, Gao C, Jia Q, Zhang M, Fu T, Li T, Wang L. Platelet-Rich Plasma Versus Corticosteroids in the Treatment of Plantar Fasciitis: A Systematic Review and Meta-Analysis. Am J Phys Med Rehabil. 2025 Jan 8.