PRP Injections vs. Shockwave Therapy for Plantar Fasciitis: Which Is More Effective?
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By Dr. Jeffrey Peng, MD · Published March 5, 2026 · 6 min read
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Plantar fasciitis is one of the most common causes of heel pain, affecting both athletes and non-athletes alike. While most cases respond well to conservative treatments such as stretching, arch support, and physical therapy, some patients continue to experience persistent pain despite months of standard care. For these individuals, newer treatment options like platelet-rich plasma (PRP) injections and extracorporeal shockwave therapy (ESWT) offer promising alternatives that aim not just to reduce symptoms, but to promote actual tissue healing.
But which of these two treatments is more effective? A clinical study published in the Journal of Foot and Ankle Surgery directly compared PRP and shockwave therapy in patients with chronic plantar fasciitis, providing valuable data to help answer this question (Alessio-Mazzola et al., 2023).
How Do PRP Injections and Shockwave Therapy Work?
PRP injections use a concentrated preparation of the patient’s own blood platelets, which contain growth factors that promote tissue repair. After a blood draw, the sample is processed in a centrifuge to concentrate the platelets, and the resulting preparation is injected directly into the damaged plantar fascia under ultrasound guidance. The goal is to stimulate a biological healing response at the site of injury.
Extracorporeal shockwave therapy takes a different approach. It delivers focused acoustic energy waves to the affected area using a handheld device. These sound waves create controlled microtrauma that stimulates blood flow, promotes tissue regeneration, and helps break down scar tissue. Treatments are typically performed over multiple sessions.
What Does the Research Show? PRP vs. Shockwave at 2 Years
The study by Alessio-Mazzola et al. was a retrospective comparative study that enrolled 55 consecutive patients with chronic plantar fasciitis and followed them for a minimum of two years. Twenty-eight patients received PRP injections while 27 underwent focal extracorporeal shockwave therapy.
In the PRP group, ultrasound-guided injections were administered once per week for three weeks, with each injection containing a platelet concentration approximately two to three times that of whole blood. Patients were instructed to avoid NSAID medications during and for at least two weeks after treatment. In the shockwave group, up to five treatments were given at one- to two-week intervals using a low to medium energy level tailored to each patient’s tolerance, with an average of 4.6 sessions completed.
The key findings were encouraging for both treatments. Both the PRP group and the shockwave group demonstrated significant improvement from baseline to final follow-up in all outcome measures, including pain scores and functional assessments. Patient satisfaction levels were similar between groups, and no patient in either group required surgery during the follow-up period.
However, important differences emerged. The overall failure rate was higher in the shockwave group at 11 percent compared to 0 percent in the PRP group. Among athletes in the study, the mean time to return to sport was significantly faster in the PRP group at approximately 3 months compared to 6 months in the shockwave group. Patients treated with PRP also required fewer total visits and fewer additional interventions over the two-year follow-up.
Could PRP Results Be Even Better?
While the study results favor PRP, there is reason to believe the outcomes could have been even more impressive with current PRP preparation methods. The protocol used in this study involved drawing 450 cc of blood, processing it, and then separating it into four shares for cryopreservation. Only a small portion was used for each treatment session, delivering approximately 2 to 3 billion platelets per injection.
In my practice, platelet count and concentration are critically important factors in PRP treatment outcomes. This study administered a total of roughly 6 to 9 billion platelets across three injections. Newer PRP preparation systems can deliver 8 to 10 billion platelets in a single injection. This means that patients could potentially achieve comparable or even superior results with just one treatment session, reducing both the number of visits and the overall treatment burden.
Which Treatment Is Right for You?
Both PRP and shockwave therapy are effective options for chronic plantar fasciitis that has not responded to standard conservative care. The study suggests that PRP may offer advantages in terms of lower failure rates, faster return to activity for athletes, and fewer required visits. However, both treatments produced meaningful, lasting improvements at two years.
Ultimately, the choice between these two treatments depends on several factors, including your activity level, treatment goals, and individual clinical situation. If you are dealing with persistent heel pain and have not found relief with stretching, orthotics, or physical therapy, I would encourage you to discuss both options with your healthcare provider. You can learn more about PRP injections and shockwave therapy on my website, or schedule a consultation to determine which approach may be best for you.
References
1. Alessio-Mazzola M, Stambazzi C, Ursino C, Tagliafico A, Trentini R, Formica M. Ultrasound-guided autologous platelet-rich plasma injections versus focal ultrasound-guided extracorporeal shockwave therapy for plantar fasciitis in athletes and nonathletes: a retrospective comparative study with minimum 2-year follow-up. J Foot Ankle Surg. 2023;62(3):417-421. doi:10.1053/j.jfas.2022.10.005
Medical Disclaimer: This content is for educational purposes only and does not substitute for the medical advice of a physician. Always consult your healthcare provider before beginning any new treatment program. The information presented reflects the opinion of Dr. Jeffrey Peng and does not represent the views of his employers or affiliated hospital systems.
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