Prolotherapy plantar fasciitis treatment

Ross Hauser, MD; Danielle Matias, PA-C; Demi Foster, APRN

Prolotherapy repairs plantar fasciitis by strengthening the fascia and providing support to the arch of the foot. Prolotherapy is a treatment that regenerates and strengthens weakened structures, such as the weakened plantar fascia ligament. This is an injection treatment, usually using simple dextrose as the injectable to stimulate soft tissue repair. In many cases, simple dextrose Prolotherapy can provide significant relief.

March 2026 research from Barcelona published in the Medicina clínica (1) writes: “dextrose prolotherapy has been shown to be effective in reducing pain in the short and medium term, proving superior to placebo or isolated conservative therapies, and emerging as a valid cost-effective alternative (treatment for plantar fasciitis).”

Research:

Researchers at the University of Health Sciences in Turkey published these findings in the American Journal of Physical Medicine and Rehabilitation (2) on the evaluation of the efficacy of dextrose Prolotherapy in the treatment of chronic resistant plantar fasciitis through comparison with a control group.

In this double-blind, randomized, controlled study, the patients were divided into two groups.
- The Prolotherapy group (30 people) was administered 5 ml of 30% dextrose, 4 ml of saline, and 1 ml of 2% lidocaine mixture (15% dextrose solution), and the control group was given 9 ml of saline and 1 ml of 2% lidocaine mixture twice at a 3-week interval.
- During the 15-week follow-up period, pain intensity was measured using the visual analog scale during activity and at rest. The foot function index was used to measure pain and disability. The plantar fascia thickness was measured by ultrasonography. The measurements were undertaken before treatment and at post-treatment weeks 7 and 15.
RESULTS: Improvements in visual analog scale during activity, at rest, foot function index (all subgroups), and plantar fascia thickness measured at the 7th and 15th weeks were significantly higher in the Prolotherapy group compared with the control group. Dextrose Prolotherapy has efficacy for up to 15 weeks and can be used as an alternative method in the treatment of chronic resistant Plantar fasciitis.

Korean doctors writing in PM & R: The Journal of Injury, Function, and Rehabilitation (3) compared Prolotherapy to PRP in the treatment of chronic recalcitrant plantar fasciitis. Led by the Korea National Sports University, the researchers found all patients in both the Prolotherapy group and the PRP group showed significant improvements. They concluded: “Each treatment seems to be effective for chronic recalcitrant plantar fasciitis, expanding the treatment options for patients in whom conservative care has failed. PRP treatment also may lead to better initial improvement in function compared with dextrose Prolotherapy treatment.”

Prolotherapy treatments need to focus on the spring ligament which is also called the plantar calcaneonavicular ligament. This is one of the most important ligaments in the arch that supports the arch. But whether someone has a high arch, normal arch, flat arch, or pes planus, if they have pain and tenderness to palpation, typically they’ll respond great to Prolotherapy because Prolotherapy stimulates the repair of the injured areas. It causes the proliferation of injured soft tissue so they repair.

The atrophy of the arch or spring ligament is a problem of plantar fasciitis

spring ligament is a problem of plantar fasciitis

A study in the medical journal Foot (4) comes to us from Morinomiya University of Medical Sciences in Japan. Here the doctors made a connection between atrophy of the spring ligament and thickening of the plantar fascia.

“Although patients with plantar fasciitis show spring ligament laxity, the thickness of the spring ligament in patients with plantar fasciitis remains unclear. This study aimed to (understand) the morphological characteristics of the spring ligament in patients with plantar fasciitis based on an ultrasound imaging system.

Thirty feet of 30 patients (painful group) diagnosed with plantar fasciitis at our hospital and thirty feet of 30 healthy volunteers (healthy group) without plantar pain were investigated.

The thicknesses of both the spring ligament and plantar fascia were assessed via ultrasound and a statistical comparison of the spring ligament and plantar fascia thickness between the painful and healthy groups was assessed.

The spring ligament thickness in the painful group was significantly lower than that in the healthy group. The thickness of the plantar fascia in the painful group was significantly greater than that in the healthy group. In addition . . .the thicker the plantar fascia in the subjects, the thinner was the spring ligament.

In this study, the ultimate suggestion was that insoles at an early stage could prevent the onset of plantar fasciitis. We suggest the early intervention of Prolotherapy.

Prolotherapy or extracorporeal shock wave therapy?

In a study published in the journal Foot and ankle surgery (5) researchers explored treating chronic plantar fasciitis patients with Prolotherapy or extracorporeal shock wave therapy.

Study learning points:

In recent years, Prolotherapy is increasingly being used in the field of musculoskeletal medicine.
The purpose of this study was to compare the effectiveness of ultrasound-guided dextrose Prolotherapy with radial extracorporeal shock wave therapy (ESWT) in the treatment of chronic plantar fasciitis.
This randomized controlled trial was conducted on 59 patients with chronic plantar fasciitis. Patients were randomly assigned into two groups receiving three sessions of radial ESWT (29 patients) vs. two sessions of ultrasound-guided interfacial 2 cc dextrose 20% injection (30 patients).
The following outcome measures were assessed before and then six weeks and 12 weeks after the treatments:
- pain intensity by visual analog scale (VAS),
- daily life and exercise activities by Foot and Ankle Ability Measure (FAAM),
- and the plantar fascia thickness by ultrasonographic imaging.
The visual analog scale (VAS) and Foot and Ankle Ability Measure (FAAM) scales showed significant improvements in pain and function in both study groups 6 weeks and 12 weeks after the treatments.
A significant reduction was noted in plantar fascia thickness at these intervals. The inter-group comparison revealed that except for the Foot and Ankle Ability Measure (FAAM)-sport subscale which favored ESWT, the interaction effects of group and time were not significant for other outcome measures.
Dextrose Prolotherapy has comparable efficacy to radial ESWT in reducing pain, daily-life functional limitation, and plantar fascia thickness in patients with PF. No serious adverse effects were observed in either group.

A February 2022 study in The Journal of Foot and Ankle Surgery (6) also compared the effectiveness of extracorporeal shockwave therapy (ESWT) versus dextrose Prolotherapy on pain and foot functions in patients with chronic plantar fasciitis

A total of 29 patients in whom conservative care failed were enrolled in the study after the clinical and ultrasonographic assessment.
The patients were randomly assigned to receive ESWT (15 patients) or dextrose Prolotherapy (14 patients).
ESWT group received 1 treatment
The dextrose Prolotherapy group underwent an injection of 5 ml of 15% dextrose solution with 2% lidocaine. (Our note: One injection of dextrose is one injection of dextrose we do not consider it a Prolotherapy treatment).

Results of three ESWT sessions versus three single injections of dextrose:

ESWT and dextrose Prolotherapy were repeated 3 times by 2 weeks apart.
Symptoms such as morning pain, and foot function improved significantly in both treatment groups at 6 weeks and 12 weeks compared to baseline.
In (this) study dextrose Prolotherapy and ESWT had similar effectiveness in patients with chronic plantar fasciitis who have not responded to conservative care. The results showed that ESWT and dextrose Prolotherapy were not superior to each other.

One injection of cortisone and one injection of Prolotherapy

Plantar fasciitis is more of a misnomer since “itis” means inflammation, and most patients who have been diagnosed with plantar fasciitis actually have weakened degenerated plantar fascia. The true inflamed tissue is hot to the touch, red, and swollen. Thus, the anti-inflammatory treatments do not promote repair and healing of the fascia because most cases of this type of foot pain are not truly inflammatory.

A study from 2023 published in the journal Foot and Ankle Specialist (7) compared one injection of cortisone and one injection of dextrose.

We would like to point out that a single injection of dextrose should not be considered a Prolotherapy treatment. It should be considered a single shot of dextrose. A single Prolotherapy treatment would be considered a “peppering of the area,” with the needle to address the ligaments and tendon attachments as described above.

Let’s however see how one injection of dextrose did against one injection of 40 mg methylprednisolone.

A total of 44 patients suffering from chronic plantar fasciitis who visited a physical medicine and rehabilitation clinic were enrolled in the study.
Two table-randomized groups were formed. They received an ultrasonography-guided, single injection of either 40 mg methylprednisolone or 20% dextrose.
Both interventions significantly improved pain and function at 2 and 12 weeks post-injection.
Conclusion: Both methods are effective. Compared with dextrose Prolotherapy, our results show that corticosteroid injection may have superior therapeutic effects early after injection, accompanied by a similar outcome at 12 weeks post-injection.

One injection of dextrose was just as good as one injection of cortisone by 12 weeks.

A November 2023 paper in the Archives of Physical Medicine and Rehabilitation (8) reviewed the effectiveness of hypertonic dextrose prolotherapy in plantar fasciopathy compared with other non-surgical treatments. Low certainty evidence demonstrated that dextrose prolotherapy was superior to normal saline injections in reducing pain and improving function in the medium term, but moderate certainty evidence showed that dextrose prolotherapy was inferior to corticosteroid in reducing pain in the short term.

A March 2022 review study (9) found “dextrose prolotherapy is an effective treatment of chronic plantar fasciitis to reduce pain, improve foot functional score and decrease plantar fascia thickness at short-term follow-up.” The paper also tells us that further studies in larger populations are needed to identify the optimal treatment regimen including dextrose concentration, volume, injection site, injection technique, and the number of injections required. The long-term effects of these treatments also require further examination.

A study conducted in December 2024 (10) evaluated the efficacy of ultrasound-guided corticosteroid injections compared to ultrasound-guided dextrose prolotherapy for treating patients diagnosed with plantar fasciitis. The study included 38 patients with confirmed plantar fasciitis, consisting of 24 females and 14 males, with an average age of 48 years. In the corticosteroid injection group, participants received methylprednisolone, while those in the prolotherapy group were treated with dextrose. Ultrasound guidance was utilized throughout the procedure to ensure accuracy and safety. Patients were monitored and evaluated at two follow-up intervals: one month (short term) and three months (middle term) post-treatment. The primary outcomes assessed were pain severity and foot function. Both treatment groups demonstrated significant improvements in pain severity and foot function index by the middle term. The enhancement was somewhat more notable in the dextrose prolotherapy group. Conversely, in the corticosteroid injection group, the treatment’s effectiveness appeared to decline over time.

A March 2026 meta-analysis study (11) in the Journal of foot and ankle research incorporated five randomized controlled trials and two cohort studies, involving a total of 567 patients diagnosed with plantar fasciitis. The primary aim was to evaluate and compare the effectiveness of corticosteroid (CS) injections and dextrose prolotherapy in managing pain and improving foot function.

The analysis demonstrated that, at the 1-month follow-up, corticosteroid injections outperformed dextrose prolotherapy in reducing pain as measured by the Visual Analog Scale (VAS). Specifically, patients receiving corticosteroid injections reported greater reductions in general VAS pain scores, VAS pain score for the first step in the morning, and VAS pain score while walking.

Additionally, corticosteroid injections led to a significantly greater reduction in the Foot Function Index (FFI) score and plantar fascia thickness compared to dextrose prolotherapy.

At the 3-month follow-up, the analysis indicated a significant improvement in the Foot Function Index score for patients treated with dextrose prolotherapy compared to those who received corticosteroid injections. However, there were no notable differences between the two groups in terms of VAS pain scores or plantar fascia thickness at this stage.

In summary, corticosteroid injections provided greater short-term relief for pain and improved foot function in patients with plantar fasciitis compared to dextrose prolotherapy. Over the mid-term follow-up period, the efficacy of both treatments became comparable, with dextrose prolotherapy showing superior outcomes in foot function. To minimize potential biases, future research should focus on trials with standardized protocols and extended follow-up periods.

A February 2026 study in the journal Scientific reports (12) researchers conducted a comprehensive systematic review and network meta-analysis that encompassed 63 randomized controlled trials, including a total of 4,170 participants. The primary objective was to evaluate the efficacy of extracorporeal shock wave therapy, prolotherapy, and various injection-based therapies for plantar fasciitis. The injection-based therapies studied included platelet-rich plasma, botulinum toxin A, corticosteroids, autologous blood, and local anesthetics.

Botulinum Toxin A: This therapy demonstrated the most significant short-term improvements in both pain relief and reduction of plantar fascia thickness.
Prolotherapy: Among the interventions, prolotherapy was found to be the most effective for providing sustained pain relief over the mid- and long-term follow-up periods.
Corticosteroid Injection: The use of corticosteroids resulted in the largest short-term gains in functional outcomes for patients.
Platelet-Rich Plasma: This intervention supported notable long-term improvements in both functional ability and plantar fascia thickness.
Extracorporeal Shock Wave Therapy: This modality demonstrated broad efficacy, showing positive effects across all evaluated domains and at each follow-up time point.

We have almost three decades of experience in the use of Prolotherapy and case histories of nearly thirty years. Prolotherapy can be an effective treatment for Plantar Fasciitis.

Plantar fascia tears

In this video, Danielle R. Steilen-Matias, MMS, PA-C, discusses typical treatments for Plantar Fascia tears.

Summary:

Plantar Fascia tears are different than Plantar Fasciitis. Fasciitis means inflammation from degeneration. The tear is a tear. If the fascia is completely torn off the bone, surgery will be needed to correct it. If the fascia is not completely torn off the bone then we can expect that would be able to help the condition with Prolotherapy.
Many patients with tears have had boot therapy, medications, rest, and massage. In our clinic, we treat this differently because we are trying to get the tear to heal more aggressively. Here we would use Prolotherapy and when needed PRP and injections. These injections are performed under ultrasound guidance.
In some patients, we would recommend a walking boot following the treatment to assist the accelerated healing. This is, of course, different than if you boot it on your own. We have seen many patients over the years who had the walking boot and while the boot provided stress and discomfort relief, it does not allow the fascia to heal the way the patients had hoped for. In our experience, booting is optimal when tissue is regenerating through treatments. Heel spurs are due to weakened ligamentous support of the plantar fascia. Prolotherapy to strengthen the plantar fascia will eliminate chronic heel pain. There is generally no need for heel spurs to be surgically removed after the supportive ligaments and plantar fascia have been repaired.

We hope you found this article informative and that it helped answer many of the questions you may have surrounding your Plantar Fasciitis, Plantar Fasciopathy, and Plantar Fasciitis tears problems. If you would like to get more information specific to your challenges of peroneal tendon injury and ankle instability, please email us: Get help and information from our Caring Medical staff

Read our published research

Evidence-Based Use of Dextrose Prolotherapy for Musculoskeletal Pain: A Scientific Literature Review: This paper has been cited by 45 research studies as we were able to demonstrate level 1 and 2 evidence to support the use of dextrose Prolotherapy for osteoarthritic pain and function, tendinopathies, myofascial pain syndrome, sacroiliac pain, and myofascial pain syndrome. There is level 3 evidence in support of the use of dextrose Prolotherapy for diffuse muscusloskeletal pain involving the spine, pelvis and peripheral joints. Dextrose Prolotherapy should be recommended for such musculoskeletal conditions as tendinopathy, ligament sprains, Osgood-Schlatter disease and degenerative joint disease, including osteoarthritis.