Achilles tendonitis is a frustrating and painful condition that affects runners, active individuals, and even those who have recently increased their activity levels. If rest, ice, and physical therapy haven’t worked, you may be wondering if platelet-rich plasma (PRP) therapy could be the solution.
In this blog, we’ll cover when PRP is effective, when it isn’t, and why treating the surrounding joints, ligaments, and nerves is crucial for long-term recovery.
Understanding Achilles Tendonitis
The Achilles tendon connects your calf muscles to your heel bone and is the strongest tendon in your body. However, repetitive stress from running, walking, or standing on hard surfaces can lead to pain and swelling. In many cases, the issue isn’t just inflammation—it’s degeneration. Over time, the tendon fibers weaken and don’t heal properly.
There are two main types of Achilles tendonitis:
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Insertional Achilles tendonitis – pain at the point where the tendon attaches to the heel.
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Mid-substance Achilles tendonitis – pain in the middle of the tendon, a few inches above the heel.
If left untreated, both types can lead to partial tears or even full ruptures.
How PRP Therapy Works for Achilles Tendonitis
Platelet-rich plasma (PRP) is a regenerative treatment that uses your own blood to stimulate healing. A small blood sample is taken, spun in a centrifuge, and processed to concentrate the healing platelets. These platelets contain growth factors that support tissue repair.
When injected into the damaged Achilles tendon using ultrasound guidance, PRP delivers a focused dose of healing power directly to the injured tissue. Over the following weeks and months, patients often experience:
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Reduced pain
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Improved strength
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Better mobility
When PRP Is an Effective Treatment
PRP works best when:
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Symptoms have lasted for three months or more
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Physical therapy and rest haven’t provided relief
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Imaging (MRI or ultrasound) shows tendon degeneration or microtears
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Pain is localized and not spreading
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There is no complete rupture requiring surgery
PRP is particularly effective for mid-substance Achilles tendonitis and tendinosis, where the tendon fibers have started to break down.
Why a Whole-System Approach Matters
The Achilles tendon does not function in isolation—it is part of a complex system of joints, ligaments, tendons, and nerves that all contribute to movement and stability. If only the tendon is treated, the root cause of the issue may be missed.
Some contributing factors to Achilles pain include:
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Ankle instability – If the ankle joint is loose or misaligned, the Achilles has to overwork.
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Weak ligaments – Supporting ligaments (such as the deltoid or subtalar ligaments) may cause strain on the tendon.
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Nerve sensitivity – The sural nerve or tibial nerve can contribute to lingering pain.
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Pinched nerves in the lower back – Sometimes, Achilles pain is linked to nerve compression in the spine.
To ensure long-term healing, treatment may include prolotherapy for joint and ligament support, as well as nerve treatments for pain relief.
When PRP Is Not the Right Choice
PRP won’t work in certain situations, including:
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Complete Achilles tendon rupture – Surgery is needed in this case.
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Pain caused by nerve compression – If the issue stems from a pinched nerve in the back, PRP in the tendon won’t help.
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Lack of basic conservative care – If you haven’t tried eccentric loading exercises, supportive footwear, or physical therapy, start there first.
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Seeking a quick fix – PRP works best when paired with lifestyle changes like proper movement and load management.
Real Patient Success Story
One patient suffered from chronic Achilles pain for over a year, experiencing burning and tightness after long periods of standing. Previous cortisone injections and physical therapy had failed.
After imaging confirmed mild tendinosis, further evaluation revealed ankle instability and sural nerve sensitivity. Treatment included:
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PRP for the Achilles tendon
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Prolotherapy for the ankle ligaments
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Perineural injection therapy for the nerve
The result? Within three months, the patient was walking pain-free and back to hiking.
Final Takeaways
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PRP is a great option for chronic Achilles tendonitis if conservative treatments haven’t worked.
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Treating the whole system—joints, ligaments, and nerves—ensures long-term success.
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PRP is not a magic bullet but can be highly effective in the right patient when combined with proper treatment.
If you’re struggling with Achilles tendon pain, our team at Chicago Arthritis and Regenerative Medicine can create a personalized treatment plan to help you heal.
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