Therapeutic Injection of PRP for Plantar Fasciitis and Achilles Tendonitis
PRP is an abbreviation for Platelet Rich Plasma. Plasma is whatís left when blood
cells are separated from the liquid component of human whole blood. The plasma portion
contains numerous biologic factors that have been shown to enhance healing in animal
and human studies. Some of this work dates back to the early 90ís. Clotted whole blood
has been used and studied for improving the success of meniscus cartilage repair in the
knee joint of humans since that time. At this very moment there are many applications where human serum factors arebeing used to enhance tissue and bone healing.
Reasons for the increased interest in PRP injection therapy for the treatment of tendonitis and fasciitis are:
1. It contains entirely natural products from a patientís own blood.
2. Traditional treatments for tendonitis are unreliable.
3. Repeated cortisone injections into tissue can destroy and weaken it
4. Cortisone injections into tendons of the lower extremity can lead to
rupture of those tendons
5. Long term anti-inflammatory pills only mask symptoms and do not heal
tissue and often cause gastrointestinal problems
6. The success rate for surgical management of tendonitis can vary and is
unpredictable for any individual
7. There is little if any risk for injecting oneís own blood product back into their
Does insurance pay for PRP? With the exception of Medicare, most insurance companies will cover partial reimbursement after pre-authorization if you have out of network coverage.
Candidates for PRP injection would be:
1. Adult patients (over the age of 18) who have long standing problems with
a. who have failed previous treatment
b. or have the inability to tolerate oral anti-inflammatory medications due to
medical problems or allergies.
2. These candidates should have sufficient symptoms to be considering surgery or
Patients who are NOT candidates for PRP injection
1. Patients who are on blood thinners for medical problems such as history of blood
clots or atrial fibrillation
2. Patients who are unable to comply with the post procedure instructions of rest and
immobilization due to personal or occupational demands
3. Patients who are unable to remain off of aspirin or other anti-inflammatory
products before or after the procedure
4. Patients who will not allow removal and injection of blood products into their
5. Patients who are allergic to any of the medications used (marcaine with
epinephrine and sodium bicarbonate)
The injection of PRP for tendonitis is an office based or an out patient procedure in a surgical center.30ccís of blood is drawn from the patientís arm. It is prepared and placed in a sterile single use container where it is spun in a high-speed centrifuge. The portion of the blood that contains the platelet rich plasma is drawn off into a syringe. The area to be injected is prepared using standard sterile technique.
The area is anesthetized and then anywhere from 3-5ccís of the material is injected into the affected tendon or fascia.
There can be no guarantees of success with PRP injections. Currently this is a
single injection and not a series. If one does not work, there is no current information that
further procedures are helpful. Neither can there be any guarantee with cortisone
injections, braces, physical therapy or surgery. All of these other modes of treatment have
costs involved as well and financial obligations due to co-pays and deductibles required
by the insurance contract. In studies going on right now in the United States and
elsewhere around the world, the success rate for PRP injections seems to be better than
cortisone and often more successful with less risk than surgery. Surgery remains an
option for patients who do not respond, and PRP injection does not burn any bridges for
patients who still have disabling pain from tendonitis.
Preparation for injection
1. Patients who have scheduled an injection should stop all anti-inflammatory
medications for 2 weeks prior to injection. This includes; aspirin (regular and
mini-dose 81mg pills), Advil, Aleve, Motrin (anything that contains ibuprofen),
arthritis pills such as Celebrex, Naprosyn, Arthrotec, Mobic, etc.
2. Patients should be prepared to take it easy for about 2 days after the injection.
3. A boot brace will be needed for the first 2-3 weeks.
After care following PRP injection
1. Following the procedure the patient will be asked to remain for 15 minutes to
insure that the procedure was tolerated well.
2. It is suggested to go home and not go back to work or do errands.
3. Ice should be applied to the area of injection for about 20 minutes, 3 times per day
for the next 48 hours.
4. DO NOT TAKE anti- inflammatory medications for the next two weeks.
5. Pain can make the patient fairly uncomfortable. Pain pills are prescribed for this
purpose (no driving while taking narcotic medication!!). It usually resolves in the
first few days.
6. A follow up post procedure exam will be scheduled for about 2 weeks.
3333 N. Calvert St, Suite # 550 Baltimore MD. 21218 (410) 243-1313