PRP for Heel Spur and Plantar Fasciitis: Evidence, Treatment and Limitations

Key points at a glance

• The bony spur is rarely the actual cause of pain.It is an X-ray finding that is also common in people without symptoms. The condition investigated and treated is plantar fasciopathy.[1]
• Chronic plantar fasciitis: mid-term advantage over corticosteroid injection.Meta-analysis of 24 RCTs: better pain scores at 3 and 6 months, with no difference at 1 and 12 months.[2]
• Only a small difference compared with shock-wave therapy.On average, −0.67 points on a 10-point pain scale after 3–6 months. Under defined conditions, ESWT is covered by German statutory health insurance.[3][4]
• Achilles tendon: no proven benefit.PRP showed no advantage over placebo for either chronic tendinopathy or acute rupture.[5][6]
• Independent PRP treatment remains under medical responsibility.Under Section 7(2) of the German Transfusion Act (TFG), blood donation may be collected by a physician or by qualified personnel under a physician’s responsibility. Under current case law, Heilpraktiker practitioners and podologists may not independently offer PRP as an autologous blood treatment.[7][25]

Heel spur or plantar fasciopathy?

In everyday practice, “heel spur” is often used as a catch-all term for pain under the heel. Medically, the term describes a bony projection at the calcaneal tuberosity—an imaging finding rather than a pain diagnosis. Plantar calcaneal spurs become more common with age and are also found in many people without symptoms.[1] A German-language continuing-education article therefore considers a lateral X-ray solely to detect the spur unnecessary: the finding has no therapeutic consequence.[10]

The typical first-step pain is usually caused by plantar fasciopathy at the fascial origin. Because classic inflammation is rarely present, “fasciopathy” is more precise than “fasciitis”.[9] Diagnosis is primarily clinical: pain during the first steps after rest and tenderness at the medial calcaneal tubercle. On ultrasound, fascial thickness greater than 4 mm and hypoechoic structure support the diagnosis. The APTA guideline lists differential diagnoses including heel fat-pad syndrome, stress fracture, tarsal tunnel syndrome, inferior calcaneal nerve entrapment and S1 radiculopathy.[11]

What the studies show in plantar fasciitis

PRP compared with corticosteroid injection

Most randomised studies compare PRP with a corticosteroid injection. The most recent pairwise meta-analysis of 24 RCTs involving 1,653 participants found significantly better pain scores with PRP at 3 and 6 months, but no difference at 1 month or 12 months.[2]

A similar pattern was seen in the Dutch double-blind multicentre RCT by Peerbooms et al. with 115 patients: pain fell quickly with corticosteroid and then plateaued, while improvement with PRP was slower but reached a lower pain level after 12 months. At least 25% improvement was achieved by 84% of the PRP group versus 56% with corticosteroid. However, around 30% of participants did not complete the study, and the results required adjustment for baseline differences.[12]

Limits of the evidence

Fourteen of the 24 studies in the meta-analysis were conducted in India and four in Egypt.[2] Many studies are small, and PRP preparation and injection techniques vary substantially. A 2026 network meta-analysis of 63 RCTs also supports a mid- and longer-term trend in favour of PRP over corticosteroid injection. However, the authors rated confidence in the individual comparisons from very low to high.[13] Some effect sizes reported there versus placebo are so large that they are more suggestive of heterogeneity in the primary data. The rankings should therefore be read as a signal, not as a fixed hierarchy.

PRP compared with shock-wave therapy

Six RCTs involving 432 participants show a statistically significant pain advantage for PRP after 3–6 months: on average −0.67 points on a 10-point scale.[3] That is a small difference. Whether patients actually notice it remains uncertain. The network meta-analysis shows broad effectiveness of ESWT across time points.[13] In Germany, extracorporeal shock-wave therapy for heel pain caused by plantar fasciitis is covered by statutory health insurance under defined conditions.[4] This should be part of any discussion about PRP.

Where PRP shows no benefit

Chronic Achilles tendinopathy

A 2025 meta-analysis of randomised trials found no improvement in pain or function versus placebo. The authors found signs of publication bias and advise against use until high-quality studies demonstrate a clear benefit.[5] An umbrella review of eight systematic reviews reached the same conclusion: isolated short-term pain benefits were neither clinically meaningful nor sustained.[14] A sham-controlled RCT published in JAMA is among the key trials.[15]

Acute Achilles tendon rupture

In the UK PATH-2 trial, 230 conservatively treated patients from 19 hospitals received PRP or a placebo injection. PRP showed no advantage at 24 weeks or at two years.[6]

Other causes of foot pain

Evidence is insufficient for PRP injections in ankle osteoarthritis and conservatively treated osteochondral lesions of the talus.[16] We found no robust studies for nerve entrapment, retrocalcaneal bursitis or forefoot pain.

Evidence overview

Indication and protocol in practice

The studies predominantly include chronic cases that were resistant to conservative treatment, often with symptoms lasting at least six months.[12] As a practical reference for when conservative measures can be considered exhausted, the German G-BA criterion for ESWT requires at least six months of limitation despite rest/load modification, stretching exercises and insoles.[4] Plantar-fascia and calf stretching as well as manual therapy are guideline-supported basic measures.[11] An injection does not replace them, and it does not correct a biomechanical cause such as hindfoot valgus.[13]

Almost all protocol variables, however, are not standardised:

Injection volume

2–5 ml in the corticosteroid-comparison trials[2]

Leukocyte content

Whether leukocyte-rich or leukocyte-poor PRP is superior at the plantar fascia remains unclear

Number of sessions

Many studies used a single injection[12]; an optimal number has not been established

Injection technique

Ultrasound-guided or landmark-guided, sometimes with peppering[13]; superiority has not been established

Local anaesthesia

Used beforehand in some studies[12]; effect on PRP efficacy is unclear

Pause of NSAIDs/antiplatelet drugs

Often recommended; a review found no human studies with clinical endpoints and no sufficient basis for routine discontinuation.[26] Never stop medication on your own.

Because study results are tied to specific protocols, the system, blood volume, centrifugation parameters and injected volume should be documented. We explain what matters when combining tubes and centrifuges in our article PRP tubes and centrifuges: compatibility and settings. For basics on design and selection, see What are PRP tubes?. Terms such as LR-PRP, LP-PRP and RCF are explained in the PRP/PRF professional glossary ; for device-specific conversion, use the RCF/RPM calculator for PRP centrifugation .

Safety and red flags

The fully published 2025 systematic review of PRP in foot and ankle disorders included 16 RCTs with 674 PRP patients and 749 controls. Adverse events were recorded more often with PRP (41.1% vs 33.7%); the most common event was treatment-site pain (15.1% vs 10.2%). The number needed to harm was 13. One severe pain reaction required surgical debridement; no other severe complications or infections were reported.[17] This argues against describing PRP as “free of side effects”, while serious events were still rare in the included RCTs.

A formal 2025 GRIIP consensus addresses infectious, oncological and haematological comorbidities.[18] It is more nuanced than blanket exclusion lists: previously evaluated thrombocytopenia above 50,000/µl without haematological malignancy is not automatically considered a contraindication; with active cancer, PRP is generally not recommended except in justified individual cases after oncology consultation. Many of these recommendations are based on expert consensus (predominantly evidence grade D), not high-quality RCTs. In PATH-2, exclusion criteria included diabetes, coagulation disorders and anticoagulation.[6] Repeated corticosteroid injections have been associated with plantar-fascia rupture and fat-pad atrophy.[13]

More detail on adverse effects and exclusion criteria: PRP side effects: recognising risks and managing them safely and PRP treatment: who is it not suitable for?

Legal framework: who may use PRP?

PRP is a blood preparation and is therefore relevant under German medicinal-product law. Blood collection, preparation, injection and professional responsibility must be considered separately. Section 7(2) TFG permits collection of a donation by a physician or by other qualified personnel under the responsibility of a physician.[19] This is different from an independent PRP service offered by a non-physician profession.

• In 2023, the German Federal Administrative Court ruled that collection of autologous blood, regardless of volume, is a donation within the meaning of the TFG and is therefore subject to the physician-reservation rule.[19]
• The Munich Administrative Court required a manufacturing authorisation for PRP autologous-blood treatment by Heilpraktiker practitioners[20]; in 2024, the Bavarian Higher Administrative Court expressly classified PRP plasma autologous-blood treatment as subject to the physician-reservation rule.[7] On 27 June 2025, the German Federal Administrative Court dismissed complaints against refusal to allow an appeal; the underlying case expressly included blood collection, centrifugation and subsequent injection of platelet-rich plasma.[25]
• Physicians may prepare PRP without a manufacturing authorisation for use in their own patients, but must notify the competent state authority under Section 67 AMG.[21]

Assessment based on the case law reviewed, as of September 2026. There is no specific court decision on the combination of a sectoral Heilpraktiker permit for podology and PRP; this line is an inference. This is not legal advice. The competent state authority can provide binding information on notification under the AMG. A more detailed separation of blood collection, preparation, application and delegation is provided in our article Who may perform PRP treatment?

Role of podology, costs and reimbursement

Since the German Federal Administrative Court judgment of 29 August 2024, a sectoral Heilpraktiker permit for podology can be issued nationwide in Germany.[8] It permits independent medical practice within the field of podology. Injections with autologous blood products are not part of that field. Podology nevertheless remains an important partner in the care pathway for heel pain: podologists often see patients early, identify red flags, provide pressure relief, advise on footwear and load, and monitor progress, especially in people with diabetes.

1. First contactGeneral practice or podology: history, foot status, identify red flags and refer
2. Confirm the diagnosisOrthopaedics: clinical examination, ultrasound, targeted imaging only when indicated
3. Conservative foundationStretching, manual therapy, insoles and load modification for several months
4. Escalation after informed discussionESWT as a statutory-insurance benefit; injection procedures such as corticosteroid or PRP as medical treatment
5. Follow-up supportPhysiotherapy and podology: continue exercises, pressure relief, feedback to the treating physician

Costs and reimbursement

For heel pain, PRP is not covered by German statutory health insurance and is billed as a self-pay service under the German GOÄ fee schedule. Published practice prices are commonly around €100–400 per session (Germany, 2025/2026; figures from practice websites and not representative). Reimbursement by private insurers is not guaranteed: in 2024, the Laufen Local Court rejected medical necessity for an autologous-blood treatment in chronic Achilles tendinopathy.[22]

By contrast, ESWT has been covered by statutory health insurance since 2019 when heel pain has limited normal activity for at least six months and conservative measures have not produced relevant improvement. A maximum of three sessions per foot and disease episode is provided for; treatment may be provided by specialists in orthopaedics and trauma surgery or physical and rehabilitation medicine.[4][24] More on factors that influence PRP treatment costs: PRP treatment: costs, procedure and limitations.

Conclusion

For chronic plantar fasciopathy that has not responded to conservative treatment, PRP is a defensible medical option. The evidence provides moderately robust support for a mid-term advantage over corticosteroid injection. Serious complications were rare in the RCTs reviewed, but local adverse events—especially injection-site pain—occurred more often with PRP than with comparator injections.[17] Anyone offering PRP should communicate the limits clearly: slower onset of effect, conflicting long-term data, only a small difference compared with shock-wave therapy, no proven benefit for the Achilles tendon and no demonstrated effect on the bony heel spur.

A complete discussion should also include alternatives: ESWT as a statutory-insurance benefit[4] and low-dose radiotherapy, for which the specialty-specific DEGRO guideline assigns recommendation grade A for calcaneodynia.[23] Key open questions are large placebo-controlled trials with long-term follow-up, standardised PRP protocols and data in higher-risk groups such as people with diabetes.

Frequently asked questions

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References

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2. 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;104(7):613–621. doi:10.1097/PHM.0000000000002677
3. Daher M, Covarrubias O, Herber A, Oh I, Gianakos AL. Platelet-Rich Plasma vs Extracorporeal Shock Wave Therapy in the Treatment of Plantar Fasciitis at 3–6 Months: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Foot Ankle Int. 2024. doi:10.1177/10711007241231959
4. Gemeinsamer Bundesausschuss. Beschluss über eine Änderung der MVV-RL: Extrakorporale Stoßwellentherapie beim Fersenschmerz vom 19.04.2018. g-ba.de
5. Barreto ESR, Antunes Júnior CR, Silva IC, Alencar VB, Faleiro TB, Kraychete DC. Is Platelet-rich Plasma Effective in Treating Achilles Tendinopathy? A Meta-analysis of Randomized Clinical Trials. Clin Orthop Relat Res. 2025;483(5):779–790. doi:10.1097/CORR.0000000000003349
6. Keene DJ, Alsousou J, Harrison P et al. Platelet rich plasma injection for acute Achilles tendon rupture: PATH-2 randomised, placebo controlled, superiority trial. BMJ. 2019;367:l6132. doi:10.1136/bmj.l6132; Zwei-Jahres-Follow-up: Bone Joint J. 2022;104-B(11). doi:10.1302/0301-620X.104B11.BJJ-2022-0653.R1
7. VGH München, Beschluss vom 28.08.2024, 20 BV 23.1807, 20 BV 23.1808 (Eigenbluttherapie durch Heilpraktiker, Arztvorbehalt). gesetze-bayern.de
8. BVerwG, Urteil vom 29.08.2024, 3 C 4.23 (sektorale Heilpraktikererlaubnis Podologie). bverwg.de
9. MSD Manual Profi-Ausgabe. Plantarfasziitis. Stand 2026. msdmanuals.com
10. springermedizin.de. Plantarfasziitis (Fortbildungsbeitrag zum plantaren Fersenschmerz). 2024. springermedizin.de
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12. Peerbooms JC, Lodder P, den Oudsten BL, Doorgeest K, Schuller HM, Gosens T. Positive Effect of Platelet-Rich Plasma on Pain in Plantar Fasciitis: A Double-Blind Multicenter Randomized Controlled Trial. Am J Sports Med. 2019;47(13):3238–3246. doi:10.1177/0363546519877181
13. Tien CH, Chiu MC, Shen YL, Ko YC, Lee JJ et al. Comparative effectiveness of minimally invasive therapies for plantar fasciitis: a systematic review and network meta-analysis. Sci Rep. 2026;16:9074. doi:10.1038/s41598-026-40038-z
14. Pallikkara Kuttyadan N et al. Effectiveness of Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy: An Umbrella Systematic Review. Cureus. 2025. doi:10.7759/cureus.92652
15. Kearney RS, Ji C, Warwick J et al. Effect of Platelet-Rich Plasma Injection vs Sham Injection on Tendon Dysfunction in Patients With Chronic Midportion Achilles Tendinopathy: A Randomized Clinical Trial. JAMA. 2021;326(2):137–144.
16. Johnson LG, Buck EH, Anastasio AT, Abar B, Fletcher AN, Adams SB. The efficacy of platelet-rich plasma in osseous foot and ankle pathology: a review. Regen Med. 2023;18(1):73–84. doi:10.2217/rme-2022-0056
17. Fucaloro SP, Berhane M, Mulvey M, Bragg J, Krivicich L, Salzler M. Platelet-Rich Plasma Injections for Foot and Ankle Pathologies Have Significantly More Complications Compared With Hyaluronic Acid Injections, Saline Solution Injections, and Dry Needling: A Systematic Review. Arthroscopy. 2025;41(10):4357–4366. doi:10.1016/j.arthro.2025.03.065
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26. Magruder M, Rodeo SA. Is Antiplatelet Therapy Contraindicated After Platelet-Rich Plasma Treatment? A Narrative Review. Orthop J Sports Med. 2021;9(6):23259671211010510. doi:10.1177/23259671211010510