How PRP Injections Are Used for Foot and Ankle Tendon Problems
- Dr. Chandana Halaharvi
- 3 days ago
- 3 min read
Why Chronic Tendon Problems Are Not Simply Inflammation
The terminology around tendon pain quietly shapes how it gets treated. Tendonitis implies inflammation, and inflammation implies anti-inflammatory treatment. But when researchers examined tissue from patients with long-standing Achilles and posterior tibial tendon pain, they frequently found very few inflammatory cells.
What they found instead was disorganized collagen, abnormal small blood vessel ingrowth, and degenerated tissue. The accurate term is tendinosis, meaning degeneration rather than inflammation, and it explains why anti-inflammatory strategies so often fail in chronic cases while working well in acute ones.
Platelet-rich plasma is built around that distinction. A sample of the patient's own blood is drawn and spun in a centrifuge, separating it by density. The platelet-rich layer is concentrated to several times its normal level and injected directly into the degenerated portion of the tendon.
Platelets are not only clotting cells. Their granules hold a dense payload of growth factors, including platelet-derived growth factor, transforming growth factor beta, and vascular endothelial growth factor. Concentrating and delivering them into stalled tissue is meant to restart a repair process that has stopped progressing.
The contrast with cortisone is significant and worth understanding before choosing between them. Cortisone is a potent anti-inflammatory that often produces dramatic short-term relief. It does nothing to repair degenerated collagen, and repeated injections into or near a weight bearing tendon are associated with tendon weakening and, in the Achilles specifically, an increased rupture risk.
How PRP Differs From a Cortisone Injection
PRP works in the opposite direction. It typically causes a temporary increase in pain for several days to two weeks as the inflammatory phase of healing is deliberately triggered. Patients need to be warned about this, because feeling worse before better is otherwise alarming and leads people to conclude the injection failed.
The procedure takes roughly forty five minutes including blood draw and centrifugation. Ultrasound guidance is standard for foot and ankle work, since precise placement into the degenerated region rather than the surrounding healthy tissue appears to matter for results.
Patients from Sugar Land, Pearland, and throughout the Houston area come to Thrive Foot and Ankle for ultrasound-guided evaluation of chronic tendon pain, which shows exactly where the tissue has degenerated before any injection is considered.
Dr. Chandana Halaharvi at Thrive Foot and Ankle uses in-office ultrasound to assess tendon quality directly, so patients throughout the Houston area know what is actually happening inside the tendon before choosing a treatment.
Anti-inflammatory medication is stopped for roughly a week before and two weeks after, for the same reason it is avoided after shockwave therapy. Suppressing the inflammatory response defeats the mechanism the treatment depends on. Acetaminophen is generally acceptable for pain during that window.
Structured rehabilitation afterward is not optional. Eccentric loading protocols, where the tendon lengthens under load, guide new collagen to align along lines of stress. PRP supplies the raw material for repair, and loading determines whether that material organizes into functional tendon or disorganized scar.
What the Evidence Supports
The evidence is genuinely mixed, and anyone presenting PRP as proven is overselling it. Results for chronic Achilles tendinosis and plantar fasciosis have been encouraging in several trials and unimpressive in others. Preparation methods vary widely between systems, which makes studies difficult to compare directly.
Cost is a practical factor. PRP is rarely covered by insurance and is usually an out-of-pocket expense per injection, with some protocols calling for more than one. That reality belongs in the decision alongside the clinical considerations.
PRP is best considered for patients with imaging-confirmed tendon degeneration who have completed a genuine course of eccentric rehabilitation without adequate improvement, and who want an option that carries less risk to the tendon than repeated cortisone.
At Thrive Foot and Ankle, we evaluate chronic tendon pain with in-office ultrasound and explain honestly where PRP fits among the alternatives. Book an appointment online to have your tendon assessed.
Comments