Plantar Fasciitis: Injections and Prolotherapy

There are several types of injections offered to treat plantar fasciitis. Steroid injections are by far the most common, though other injection treatments are growing in popularity.

See Is Heel Pain Caused by Heel Spurs or Plantar Fasciitis?

These treatments are elective, meaning it is up to the patient to decide whether or not to do them. Not all are covered by insurance.

Platelet-rich plasma (PRP) injections

A platelet rich plasma (PRP) injection uses platelets from the patient’s blood in an attempt to encourage healing in damaged tissue. Data from clinical studies show that platelet rich plasma injections might be a safe and effective treatment for some people with plantar fasciitis,¹O'malley MJ, Vosseller JT, Gu Y. Successful use of platelet-rich plasma for chronic plantar fasciitis. HSS J. 2013;9(2):129-33.^,2Shetty 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.^,3Monto RR. Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis. Foot Ankle Int. 2014;35(4):313-8.^,4Tiwari M, Bhargava R. Platelet rich plasma therapy: A comparative effective therapy with promising results in plantar fasciitis. J Clin Orthop Trauma. 2013;4(1):31-5. though more research is needed.

See PRP Therapy for Chronic Tendon Injuries

This treatment requires a blood draw from the patient. It is common for patients to have a series of treatments—about 3 to 5.⁵Platelet-rich Plasma Injections. American Orthopaedic Foot and Ankle Society website. http://www.aofas.org/footcaremd/treatments/Pages/Platelet-rich-Plasma-Injections.aspx. Accessed November 1, 2016.

See Are PRP Injections Effective?

Cortisone injections (steroid injection)

Plantar fasciitis patients who are in moderate to severe pain and have not responded to treatment may be advised to have a cortisone injection. This steroid will reduce or eliminate inflammatory pain but may have an overall degenerative affect on the protective fatty pads at bottom of the foot. A physician may use imaging for guidance—to ensure the steroid injection is placed in the correct location in the foot.

Cortisone injections can also weaken the plantar fascia, putting it at an increased risk for rupture (tear). Cortisone injections also carry a risk of fat pad atrophy resulting in chronic heel pain. Because of these risks, a patient should talk to a doctor or physical therapist and get advice and approval for any exercising and stretching routine to be done during the weeks following an injection.

Stem cell injections

Many researchers believe stem cells can be used to repair and replace damaged tissues, such as injured plantar fascia tissue. Doctors typically use stem cells collected from the patient’s blood, bone marrow or body fat. More research is needed to determine the effectiveness stem cell therapy for plantar fasciitis.

See Stem Cell Therapy for Sports Injuries

Physicians may combine a stem cell therapy with platelet rich plasma therapy.

Prolotherapy

Prolotherapy treatment injections are made from a local anesthetic and an irritant, usually dextrose (a form of glucose). The irritant is used to cause inflammation. Some experts believe inflammation spurs the creation of connective tissue (collagen), which in turn helps repair tendons and ligaments—ultimately reducing pain.⁶Alternative Treatments Dealing with Chronic Pain. Mayo Clinic Health Letter. April 2005. http://www.prolotherapy.com/Mayo-Clinic-Prolo%202005.pdf. Accessed November 1, 2016.

See Types of Regenerative Medicine for Sports Injuries

Botox injections

Some research suggests that injections of Botox, or Botulinum toxin type A (BTX-A), may be a safe and effective way to relieve plantar fasciitis pain and inflammation.⁷Elizondo-rodriguez J, Araujo-lopez Y, Moreno-gonzalez JA, Cardenas-estrada E, Mendoza-lemus O, Acosta-olivo C. A comparison of botulinum toxin a and intralesional steroids for the treatment of plantar fasciitis: a randomized, double-blinded study. Foot Ankle Int. 2013;34(1):8-14.^,8Díaz-llopis IV, Rodríguez-ruíz CM, Mulet-perry S, Mondéjar-gómez FJ, Climent-barberá JM, Cholbi-llobel F. Randomized controlled study of the efficacy of the injection of botulinum toxin type A versus corticosteroids in chronic plantar fasciitis: results at one and six months. Clin Rehabil. 2012;26(7):594-606. This treatment is not common, and more study is needed.

Amniotic fluid injections

At least one study has suggested that injections containing material from the amniotic fluid and membranes of newborn humans may be used to treat plantar fasciitis.⁹Werber B. Amniotic Tissues for the Treatment of Chronic Plantar Fasciosis and Achilles Tendinosis. Journal of Sports Medicine. 2015: 1-6. As cited in Werber B. Amniotic Tissues for the Treatment of Chronic Plantar Fasciosis and Achilles Tendinosis. Journal of Sports Medicine. 2015: 1-6. This treatment is not common, but advocates suggest that the injections are have anti-inflammatory effects that promote healing and reduce scarring.

Patients may also consider other nonsurgical treatments, such as extracorporeal shock wave therapy (ESWT). If these medical interventions do not provide relief from plantar fasciitis then surgery may be considered.