Efficacy of Platelet-Rich Plasma in the Treatment of Chronic Plantar Fasciitis Compared with Other Conventional Treatments (Corticosteroids and Shockwave Therapy): A Systematic Review

Plantar fasciitis is a degenerative condition of the plantar fascia characterized by collagen fiber degeneration, increased ground-substance (extracellular matrix) proteins, focal fibroblast proliferation and increased vascularity; it is for ≥3 months and affects around 10% of the general population. This review compared the efficacy of platelet-rich plasma (PRP), an autologous source of growth factors, with corticosteroid (CS) injection, which acts through anti-inflammatory mechanisms, and extracorporeal shockwave therapy (ESWT), which acts through mechanotransduction. Following a protocol registered retrospectively in Open Science Framework (OSF) Registries, PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library and Dialnet were searched from January 2020 to September 2026 for comparative studies of PRP versus CSs and/or ESWT in adults with chronic plantar fasciitis. Screening was performed independently by two reviewers. Because of heterogeneous outcome scales, time points and reporting, pooling was not appropriate and results were synthesized narratively by comparator and follow-up period. Twenty-two primary studies (1915 patients) were included: 20 compared PRP with CSs and two compared PRP with ESWT. Short-term (≤6 weeks) results for PRP versus CSs were inconsistent, with some studies favoring CSs. From approximately 3 months onward, most studies reported lower pain (visual analogue scale), better function (American Orthopaedic Foot & Ankle Society (AOFAS), Foot and Ankle Ability Measure (FAAM), Foot Function Index (FFI)) and a greater reduction of ultrasonographic plantar fascia thickness with PRP; three studies found no difference or favored CSs. The two studies comparing PRP with ESWT reported mixed results. The available evidence suggests that PRP may provide greater medium- to long-term improvements in pain and function than CS injection, whereas short-term results are inconsistent. Evidence comparing PRP with ESWT is insufficient to draw conclusions. According to Grading of Recommendations Assessment, Development and Evaluation (GRADE), the certainty of the evidence was low for long-term pain and plantar fascia thickness and very low for the remaining outcomes and for the comparison with ESWT.