What's the Real Difference Between PRP and Cortisone Injections?
PRP (platelet-rich plasma) uses concentrated growth factors from your own blood to heal damaged tissue, while
cortisone injections use steroid medication to suppress inflammation and mask pain. PRP stimulates tissue regeneration over 3-6 months; cortisone provides rapid symptom relief for 6-12 weeks but doesn't repair the underlying damage.
Think of cortisone like a chemical fire extinguisher. It's a powerful anti-inflammatory that shuts down your body's inflammatory response. The swelling decreases, the pain quiets down, and you feel better—sometimes within 24 hours.
But here's the thing: cortisone doesn't fix what's broken. It just turns down the volume on your pain alarm.
PRP is like bringing in a full construction crew with blueprints and materials. We take your own blood, spin it down in a centrifuge to concentrate the platelets 3-5 times their normal level, and inject those healing compounds exactly where your tissue is damaged. These aren't synthetic drugs—they're your body's natural healing compounds, just concentrated and delivered exactly where you need them.
So here's the bottom line: cortisone manages symptoms temporarily, while PRP regenerates tissue permanently. Both have their place, but they're solving different problems.
How Each Injection Works (The Honest Explanation)
When I inject cortisone into your plantar fascia or inflamed tendon, it immediately starts suppressing the inflammatory cascade. It blocks an enzyme called COX-2, which reduces swelling and pain signals.
Think of it like unplugging a faulty smoke alarm. The beeping stops, but if there's still a fire burning, you haven't solved anything—you've just silenced the warning system.
What cortisone does: It calms inflammation. What it doesn't do: repair damaged collagen, rebuild torn tissue, or address the root cause of degeneration. This is why that first cortisone shot might give you 3 months of relief, but the second one only works for 6 weeks, and the third barely lasts 2 weeks. You're not addressing the degeneration—you're just temporarily masking it.
Now here's how PRP works. I draw 30-60cc of your blood, spin it in a medical-grade centrifuge to separate the platelets from the rest of your blood, and activate those concentrated platelets. What you're left with is liquid gold—growth factors that tell your damaged tissue exactly how to heal itself.
Those growth factors work like a construction crew. PDGF tells cells to multiply. VEGF grows new blood vessels to bring fresh nutrients and oxygen.
TGF-β creates new collagen to rebuild tissue strength. Together, they're like a construction crew rebuilding damaged tissue from the ground up.
Your chronically injured tissue is like depleted soil that can't grow anything anymore. PRP is like adding fertilizer packed with exactly what the soil needs to grow healthy tissue again. But here's the difference from cortisone: cortisone works in days; PRP works over months. Cortisone fades; PRP keeps improving.
After treating thousands of patients with both, here's what I've learned: cortisone is renting relief. PRP is investing in healing. One gives you 6-12 weeks of feeling better. The other gives you tissue that's actually stronger 6 months later.
And let me address something you've probably heard: "Isn't PRP experimental?" No. We have 13+ randomized controlled trials, 15+ years of clinical use, and FDA-cleared equipment. Your insurance company calls it "investigational" to avoid paying for it—not because the science isn't there.
The Research: What the Studies Actually Show
Both cortisone and PRP show similar results at first. At 3 months, both give you about 65-75% improvement in pain and function. This is where a lot of doctors stop looking at the data and conclude they're equivalent. They're not.
The divergence happens over time. At 6 months, cortisone patients drop to 40-50% improvement—the medication has worn off and the tissue is still damaged. But PRP patients? They're at 75-85% and still improving because the tissue is actively healing.
The long-term data is even more dramatic. A study from Nepal followed 60 patients with plantar fasciitis for 24 months. At that 2-year mark, the cortisone group was essentially back where they started—average functional score of 56 out of 100.
The PRP group? Still scoring 92 out of 100. That's not a small difference—that's the difference between struggling to walk and living normally.
A 2024 meta-analysis looked at 599 patients across multiple studies. PRP showed a 16.13-point functional advantage over cortisone.
And we can actually see this on imaging—ultrasound shows that PRP thickens and rebuilds plantar fascia tissue, while cortisone shows minimal structural change. This isn't subjective. We can see on imaging that PRP is rebuilding tissue architecture.
Here's the pattern I see constantly: First cortisone shot works for 3 months. Second shot works for 6 weeks. Third shot works for 2 weeks. Each injection is less effective because you're not addressing the degeneration. You're just suppressing the symptoms of tissue that's continuing to break down.
When Cortisone Makes Sense (Yes, Really)
Look, I still use cortisone injections. I'm not anti-cortisone—I'm pro-right-treatment-for-right-situation. There are times when cortisone is absolutely the smart choice.
If you twisted your ankle 2 weeks ago and it's massively swollen, cortisone is perfect. That's acute inflammation, not chronic degeneration. The tissue isn't breaking down—it's just angry and inflamed. Cortisone calms that down beautifully.
I had a bride come in 3 weeks before her wedding with severe heel and arch pain from plantar fasciitis. She needed to walk down the aisle without limping. We weren't going to heal her tissue in 3 weeks, but cortisone bought her that time. That's exactly what it's designed for—event-based relief when timing matters.
Cortisone is also incredibly useful for diagnostic confirmation. If a cortisone injection completely eliminates your pain, even temporarily, that confirms we've identified the exact location and source of your problem. That information is valuable, even if cortisone isn't the long-term answer.
And sometimes, cortisone works as bridge therapy. You can't always afford PRP immediately, or you need some relief while PRP is taking effect over those first few weeks. There's nothing wrong with that approach.
But here's when cortisone is the wrong choice. If you've been dealing with chronic tissue degeneration for 6+ months, if you've already had 2+ cortisone injections with diminishing returns, or if ultrasound shows tissue breakdown instead of inflammation—cortisone isn't going to solve your problem.
I have a strict rule: maximum 2 cortisone injections per year per location. After that, we're not managing your problem anymore—we're creating new ones like fat pad atrophy and tendon weakening. At that point, it's time to look at regenerative options.
When PRP Is the Better Choice
Most doctors give you two options: keep suffering through conservative care that's not working, or go straight to surgery. PRP is what I call The Third Option—regenerative medicine that actually heals tissue instead of just managing symptoms or cutting things out.
Here's who benefits most from PRP. If you've been dealing with foot pain for over 6 months, your tissue isn't inflamed anymore—it's degenerated. The collagen has broken down, blood supply is poor, and your body's natural healing process has stalled out. That's exactly what PRP treats best.
You've done the stretches, bought the expensive custom orthotics, tried physical therapy—and you're still hurting. That tells me we need to stimulate actual tissue regeneration, not just manage symptoms. Conservative care has its limits, and you've reached them.
When cortisone relief drops from 3 months to 6 weeks to 2 weeks, that's your body telling you the problem is degenerative. Cortisone failure is actually good diagnostic information—it points directly to PRP as the next step.
If you're on your feet all day—teacher, nurse, construction worker—or you're an athlete who needs durable healing, PRP gives you tissue strength that lasts. You're not looking for 6 weeks of feeling better. You need tissue that can handle daily stress without breaking down again.
And if you're facing plantar fascia release or Achilles surgery and want to try everything first, PRP should be on that list. It's not a guarantee, but it gives you a legitimate shot at avoiding the operating room.
What does PRP treat best? Chronic plantar fasciitis or fasciosis, Achilles tendinopathy, posterior tibial tendonitis, chronic ankle instability, and moderate cases of Morton's neuroma. These are all degenerative conditions where your body's healing has stalled.
The honest data: 80-90% of people experience significant, lasting improvement with PRP. But that means 10-20% don't respond as well. I can't promise you'll be in the 80-90%, but those are better odds than cortisone's 20-30% long-term success rate.
The Cost Question Everyone's Thinking About
Let's talk about money, because I know that's on your mind. Cortisone is typically covered by insurance—you'll pay your copay, maybe $20-50. PRP isn't covered by most insurance plans, and it costs $800-1,200 per injection.
Insurance covers cortisone because it's been around for 60 years and it's cheap to produce. They call PRP "investigational" despite 15 years of research because they don't want to pay for prevention—they'd rather pay for surgery later. I know that sounds cynical, but it's the reality I've watched for 25 years.
Run the numbers. With cortisone, you're paying $50 copay × 3-4 shots per year × multiple years. That's $600-800+ ongoing, and you're still in pain. With PRP, you're paying $800-1,200 × 1-2 treatments for lasting improvement.
Which is more expensive: renting relief every 8 weeks, or investing in healing once?
We offer payment plans because I don't want cost to be the only reason you keep suffering. And honestly, some people do cortisone first while they save for PRP—that's a legitimate strategy.
What's it worth to walk without pain for years instead of weeks? To stop the cycle of shots every few months? To potentially avoid a $10,000 surgery with 6 months of recovery? That's the real cost-benefit analysis.
Houston Podiatrist Treats Foot Pain with PRP and Cortisone
When you come in to see me with chronic foot pain, I'm not going to immediately reach for a needle. My job is to figure out what's actually causing your pain, what stage of tissue damage we're dealing with, and which treatment gives you the best chance at long-term healing. Sometimes that's cortisone. Often, it's PRP. Occasionally, it's neither—at least not yet.
I start with a detailed history. How long has this been going on? What makes it worse? What have you already tried? Then I examine your foot—palpation, range of motion, watching how you walk. Dr. Schneider uses in-office diagnostic ultrasound because he can see tissue thickness, tears, inflammation, and degeneration in real-time. Sometimes we need X-rays too.
Then I make the clinical decision: Is this inflammatory or degenerative? Acute or chronic? Injectable or not?
Lifestyle Modifications
I don't care how badly you want an injection—we start with the basics, because sometimes that's all you need. Your feet need supportive shoes even at home, not flip-flops or walking around barefoot on hard floors. Weight matters too—every pound you lose removes 3-4 pounds of pressure from your feet.
We need to swap high-impact activities for low-impact ones temporarily. Running becomes cycling or swimming. Standing all day gets broken up with sitting breaks. Ice therapy after activity—15-20 minutes with a frozen water bottle under your arch.
For about 30-40% of early-stage cases, these changes are enough. But it requires 6-8 weeks of consistent effort. If you've already been dealing with this for 3+ months, lifestyle changes are necessary but rarely sufficient on their own.
When to escalate: If there's no improvement after 6-8 weeks, if pain is interfering with daily activities, or if I see degeneration on ultrasound.
At-Home Therapeutic Care
My structured home program covers stretching, strengthening, and self-treatment techniques that actually work. Daily plantar fascia and calf stretching, 30 seconds each, three times a day. Foot strengthening exercises like picking up marbles with your toes. Night splints to keep your fascia stretched while you sleep.
Here's the honest truth about night splints: they work for about 60% of people who can tolerate wearing them. Most people don't make it past 3 weeks because they're uncomfortable and disrupt sleep. I won't judge you for that—I just need you to be honest with yourself about whether you're actually doing it.
Success rate with genuine compliance: 35-50%. Timeline: 8-12 weeks of daily effort. When to escalate: No improvement after 8 weeks of actual consistent effort, pain worsening despite compliance, or quality of life severely impacted.
Conservative In-Office Treatment
If you have flat feet, high arches, or overpronation, custom orthotics address a root biomechanical cause. We do a 3D foot scan, custom fabricate the orthotic to your exact foot shape, and you wear them in supportive shoes. Cost is $400-600, sometimes covered by insurance.
Success rate: 55-65% when combined with other treatments. They don't heal damaged tissue, but they prevent future damage by redistributing pressure properly.
Cortisone injections also fit in here—when appropriate. I use cortisone for acute inflammatory flares, event-based relief needs, or as bridge therapy. I don't use it for chronic degeneration—that's where it fails.
What to expect with cortisone: I perform an ultrasound-guided injection that takes about 5 minutes. You'll typically get 6-12 weeks of relief. Success rates are 75-85% short-term (1-4 weeks), 40-50% medium-term (3 months), and 20-30% long-term (6+ months).
Maximum 2 cortisone injections per year per location. After 2 shots, if you're not better, cortisone isn't your answer—we need to move to regenerative medicine. Risks include fat pad atrophy (10-15% with single injection), plantar fascia rupture (2-3%), skin depigmentation (5-8%), and tendon weakening.
Physical therapy runs 6-8 weeks, twice weekly. Success rate is 60-70% with compliance. PT is great, but it can't regenerate degenerated tissue—it can only strengthen what's there.
Advanced Regenerative Medicine (The Third Option)
At the advanced level, we stop managing symptoms and start actually healing tissue. What's exciting is that we now have treatments that almost make surgery obsolete for most chronic foot pain.
Shockwave Therapy (EPAT): High-energy acoustic waves stimulate new blood vessel growth in damaged tissue. We do
5-6 treatments spaced 5-7 days apart. It's moderately uncomfortable during treatment—about a 5-6 out of 10—but there's no downtime afterward.
Success rate: 82% experience significant improvement, with 65-70% achieving complete pain resolution. Timeline: 8-12 weeks post-treatment for peak benefit. Cost: $2,100-3,000.
EPAT is my go-to for chronic plantar fasciitis, especially when I see heel spurs on X-ray. That 82% success rate is hard to argue with.
PRP Therapy ("Liquid Gold"): Here's what makes our PRP different. I use a medical-grade centrifuge that concentrates platelets 3-5 times normal levels. Every injection is ultrasound-guided so I can see exactly where the PRP is going. And I personally perform every injection—this isn't delegated to an assistant.
The process: I draw 30-60cc of your blood, centrifuge it for 15 minutes to separate the platelets, activate them with calcium chloride, then inject under ultrasound guidance. You rest with ice for 15 minutes afterward.
Most people need 1-2 injections. If you need a second one, we space them 4-6 weeks apart.
Timeline expectations matter. Weeks 1-2: Increased soreness—that's healing inflammation, and it's expected. Weeks 3-6: Gradual pain reduction begins. Weeks 8-12: Significant improvement becomes obvious. Months 4-6: Peak benefit. Long-term: Continued improvement up to 12 months.
Success rates: 65-75% at 3 months, 75-85% at 6 months, 80-90% at 12 months, and 85% maintain improvement at 24 months. Cost: $800-1,200 per injection.
I call PRP "liquid gold" for a reason. When a patient comes back 6 months later and tells me they're still pain-free—not needing another shot, not managing symptoms, but actually healed—that's why I invested in this technology for my Houston practice.
For severe chronic cases (12+ months of pain), I sometimes combine EPAT and PRP. Success rate jumps to 88-92%. Cost: $3,000-4,500. This is what I recommend when someone is literally on the surgery waitlist but wants one final shot at healing.
Surgery (When Necessary)
Look, I know foot surgery sounds scary. But here's the truth: 95% of foot pain cases resolve without ever needing surgery. You're probably not going to end up in an operating room.
For the 5% who do need it, plantar fascia release involves partially cutting the plantar fascia to relieve tension. Success rate: 75-85%. Recovery: 6-12 months to full function. Complication rate: 10-15%.
When I refer for surgery: Failed conservative care for 12+ months, no response to EPAT or PRP, imaging-confirmed severe damage, and debilitating pain that prevents normal life.
I don't perform surgery myself—I'm focused on conservative and regenerative care. I will never send you to surgery prematurely. We'll exhaust every reasonable non-surgical option first.
[MID-ARTICLE CTA: Ready to find out which treatment is right for your foot pain? Call our Houston office at 713-785-7881 or request an appointment online.]
What to Expect When You Visit Tanglewood Foot Specialists
When you come in, I'll start by listening. Not skimming a chart, not rushing to examine you—actually listening. I want to know how long this has been going on, what makes it worse, what you've already tried, and what your goals are. Are you training for a marathon? Just want to walk your dog without grimacing? Need to stand through a full nursing shift? Your goals matter, because they shape which treatment path makes the most sense for you.
After we talk, I'll do a thorough physical examination. I'll palpate the painful area to isolate exactly where the damage is, assess your range of motion, and watch how you walk. Gait analysis tells me a lot about the mechanical forces that may be contributing to your problem. Then I'll use in-office diagnostic ultrasound to look at your tissue in real-time—I can see thickness, tears, inflammation, and degeneration right there in the exam room. If I need to rule out a stress fracture or bone spur, I can take X-rays in the office too. I want the full picture before I say anything about treatment.
Here's what I won't do: pressure you. I'll show you the ultrasound images, walk you through what I'm seeing, and explain your options from least to most invasive. You'll hear the success rates, the realistic timelines, the costs, and what to expect with each path. Then we'll decide together.
If cortisone is appropriate, we can often do that injection the same visit. PRP takes a little more preparation—I need to draw and process your blood—but that can also happen same-day if your schedule allows. Most first appointments run 45-60 minutes. I'd rather take the time to get it right than rush you in and out.
Follow-up depends on what we do. If you get a cortisone injection, I'll want to see you back in 2 weeks to assess how you responded. After PRP, we check in at 4-6 weeks to evaluate progress. Either way, I need to see you so we can track how your tissue is healing and adjust the plan if needed.