PRP vs Steroids for Plantar Fasciitis

by Chris Centeno, MD /

prp vs steroids for plantar fasciitis

Steroid injections for painful body parts are a medical standard that represents the worst of traditional medicine. Why? Steroids are toxic substances to the body that also happen to be powerful anti-inflammatories. Now the latest study of steroid injections versus platelet rich plasma (PRP) has hopefully put another nail in the proverbial steroid coffin. Let me explain.

What You’re Really Getting with an Injection of Steroids

Most patients are familiar with steroid injections, but most have no idea that PRP injections are an alternative to treat many of the same issues. It’s well known that steroids are bad news, but many patients agree to steroid injections in the hopes that the benefits will outweigh the risks. What you might not know is just how toxic these drugs really are. So let’s review what you’re really getting when you get a steroid injection.

Cartilage Damage

High-dose steroid injections destroy cartilage. That steroid injection into your knee, for example, might provide you with some temporary pain relief, but behind the scenes it’s wreaking havoc on your joint-cushioning cartilage. If you think you’re off the hook because your steroid injections are being injected into your foot for plantar fasciitis, think again. Your foot contains many tiny joints, all cushioned with cartilage to help provide smooth movement.

Diminishing Relief

Repeated steroid injections have been shown to provide diminishing relief with each subsequent injection. So while the first injection may provide some relief, the second provides less and the third even less and so on. Why? Possibly because of the toxic effect steroids have on the local repairing stem cells…

Poisoned Stem Cells

Your body’s own stem cells are powerful cells that respond to damage and immediately get to work repairing it when it occurs. One study found that when mesenchymal stem cells are exposed to steroids, this, in effect, poisons the cells, stifling their ability to become bone and to repair bone. With no strong stem cells to stop it, wear and tear sets in and bone damage occurs. In other words, the steroid-damaged local stem cells can’t keep up with their job of repairing. Even more disturbing, another study found that some steroids, even in smaller-than-typical doses, completely wiped out all of the local stem cells.

Increased Risk for Spinal Fractures

Bone loss and osteonecrosis are well-known potential risks of steroid treatments, but one you might not be as familiar with is fractures. It makes sense as weakened bone will lead to greater risks of fractures, but one study found that the risk for spine fracture increased with each steroid shot by a stunning 29%.

Decreased Blood Supply

In order to stay healthy and effectively heal, tissues need a good blood supply. One study, however, found that when comparing patients who were undergoing rotator cuff surgery and had steroid injections prior to the surgery to those who didn’t have steroids, the steroid patients had one-third fewer blood-supply vessels.

Adrenal Insufficiency

Hormone tests in one study provided evidence that 60% of patients who had steroid injections into their knees developed adrenal insufficiency. In many of these patients, the adrenal issue was still present two months after the steroid injection. Symptoms of adrenal insufficiency include depression, muscle fatigue, hypotension, kidney failure, and so on.

So if you have plantar fasciitis, is there an alternative for steroid injections? Yes! Platelet rich plasma, or PRP…

What You’re Getting with an Injection of PRP

Platelet rich plasma (PRP) is concentrated from blood platelets, which are the body’s natural growth factors and healing molecules. When you have an open wound, such as a finger laceration or a skinned knee for example, it’s your platelets that rush in and start clotting your blood to stop the bleed. Your growth factors also kick in to encourage healing. It’s how the body heals itself when minor injuries occur.

To obtain PRP, blood is drawn from a vein and the whole blood is centrifuged, or rapidly spun. Centrifuging separates the plasma serum where the platelets are concentrated; hence, the result is a platelet rich plasma.

Injections of a patient’s own PRP stimulate the body’s local stem cells to wake up and start repairing damaged tissues. So PRP is like a shot of espresso for our repairman cells. PRP is used to treat many orthopedic conditions, such as muscle, ligament, and tendon tears, sprains, arthritis, and much more.

Our feature study today studied PRP vs steroids for plantar fasciitis and supports PRP as a safe, effective, and long-lasting solution over steroids for plantar fasciitis. Let’s take a look.

Study Favors PRP vs Steroids for Plantar Fasciitis

The purpose of the new study was to compare the impact of PRP versus steroid injections on chronic plantar fasciitis. Both outcomes and imaging (ultrasound and MRI) were analyzed in 40 patients with plantar fasciitis—20 received PRP and 20 received steroids. Subjects were evaluated at three and six months following treatment.

The results? While there were improvements in both groups, the PRP group showed significant improvement over the steroid group. Researchers concluded that PRP injections are a “more effective therapeutic method” than steroid injections. In addition, the study goes on to say that not only is PRP safe, but that PRP treatment provides a longer-lasting solution than steroids.

The upshot? This is one of many studies that now show that PRP is better than steroids and doesn’t have the nasty side effects. Now we just need insurance companies to get the memo! In the meantime, if you’re a patient who is getting or about to get a steroid injection, spend a little on yourself and upgrade to a PRP shot. You’ll be glad you did!

Category: Foot

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8 thoughts on “PRP vs Steroids for Plantar Fasciitis

  1. Ed Capps

    Dr Centeno once said that if surgery is necessary, there is an anaesthesia agent that is less harmful than others. Is there a way to access that?

    1. Regenexx Team

      Ed,

      Here’s the Blog that explains which type of anesthesia and combinations to avoid and which type is better: https://regenexx.com/blog/general-anesthetics-and-dementia-new-research-raises-concerns/ Be well Ed!

  2. Elise Chamberlain

    Thank you so much for the regenexx blog. I feel I’ve been thoroughly educated. But, there is one question I have, and that is are stem cells still good when one is in their 70’s? I hear they are old and will not regenerate like amniotic stem cells.
    Also, when is the difference between “not live” and “live”.
    Please answer soon because I need to make a decision.

    1. Regenexx Team

      Elise,
      Yes, they are still good. In order for something to regenerate, it needs to be “live” and “viable”. The test for that is to give cells an opportunity to grow in culture, the same way they will grow, or not grow, in your body. Unfortunately, non of the Amniotic “stem cell” products we’ve tested, or had a non profit lab test, have passed that test. This will help explain: https://regenexx.com/blog/does-age-affect-stem-cell-treatment/ and (https://regenexx.com/blog/serious-public-health-issue-exposed-bait-switch-fraud/ and
      https://regenexx.com/blog/amniotic-stem-cell-update-wrong/

  3. ERVIN MARSTON

    I have both shoulders bone on bone and have had several injections with no effect on the last one so no more for me!I live in Maine (Bangor)am 81 and ret USAF Vet and in exllent shape.Hope to live 19 yrs more! Where or who can do this STEM Cell. Keep up your great work and wish our gov would wake up on this and to hell with the WALL!! Ervin Marston Ret USAF C/Msgt

    1. Regenexx Team

      ERVIN,

      Thanks Ervin, and thank you for your service! Steroid injections make things worse in the long run, so a very good idea to stop. Vermont Regenerative Medicine would be the closest, and a great place to go. Please see: http://vermontregenerativemedicine.com/

  4. Sean M Weiss

    I’ve been battling plantar fasciitis for 6-8 years and have had multiple injections. The DPM now says I also have Achilles tendonitis… Will PRP help this and for the injections are they done under local or under anesthesia such as prop?

    Can both feet be done at same time or best to have one then the other? How long is recovery (off my feet)?

    Thank you!

    1. Regenexx Team

      Sean,
      We treat planatar fasciitis and achilles tendonitis regularly. Because no surgery is involved, the precise image guided injections of the patient’s own platelets or stem cells, are done in high level procedure suites and only local anesthetics are needed. Recovery is very minimal, compared to surgery. If you’d like to see if you would be a Candidate, please submit the Are You a Candidate form or let us know here.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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