Orthobiologics continue to expand the treatment landscape between conservative care and surgical intervention, particularly in foot and ankle pathology.
In a recent APEX educational webinar, foot and ankle surgeon Jason Piraino, DPM and Ariana DeMers, DO, RMSK explored how platelet-rich plasma (PRP) and protein concentrate (PC) can be applied within a structured, pathology-driven algorithm.
PRP is often misunderstood as a standardized treatment. In reality, it represents a spectrum of biologic formulations derived from autologous blood.
As emphasized in the discussion, outcomes are not solely dependent on PRP itself but on how well the formulation is matched to the biological environment.
PRP functions through signaling, not direct tissue regeneration - initiating angiogenesis, cell recruitment, and collagen synthesis.
A central theme of the webinar was the mismatch problem.
Different tissues require different biologic strategies:
Using the same PRP formulation across all indications often leads to inconsistent results.
Clinical success depends on selecting the right biologic for the right tissue.
PRP formulation should be tailored based on indication:
Common applications:
Primary goal:
Stimulate inflammation and support the healing cascade.
Common applications:
Primary goal:
Reduce inflammation and support joint homeostasis.
This distinction is critical for optimizing outcomes and minimizing unnecessary inflammatory response.
Protein concentrate (PC) represents an emerging adjunct in orthobiologic therapy.
Derived from platelet-poor plasma, PC concentrates key anti-inflammatory mediators such as:
PRP promotes healing.
Protein concentrate helps protect the joint from further breakdown.
When used together:
This combination may help optimize the intra-articular environment, particularly in early osteoarthritis.
Common treatment areas:
Typical approach:
Evidence suggests potential for:
One of the most supported indications for PRP in foot and ankle.
Key Considerations:
PRP may offer a more durable approach compared to symptom-focused interventions.
Common Applications:
Reported Outcomes:
Evidence remains mixed
Current Findings:
This highlights the importance of:
PRP may support:
Particularly relevant in athletes and acute injury settings.
Biologic variability begins with the patient.
Important considerations:
Even short-term interventions, such as light exercise prior to blood draw, may influence platelet yield.
Effective communication is essential.
Rather than focusing on technical details, framing should emphasize:
This improves patient understanding and alignment with treatment expectations.
Dr. DeMers outlined a structured framework:
This approach supports consistency and scalability within clinical practice.
As orthobiologic therapies continue to gain traction across musculoskeletal medicine, successful implementation depends on more than simply adopting PRP into practice. Outcomes are heavily influenced by patient selection, biologic formulation, tissue pathology, procedural technique, and post-procedure management.
This discussion reinforces the importance of approaching PRP and PC as customizable biologic tools rather than one-size-fits-all treatments. From plantar fasciitis and tendon pathology to early osteoarthritis and joint preservation strategies, biologic therapies may offer clinicians an opportunity to bridge the gap between conservative care and surgical intervention through a more pathology-driven, evidence-guided framework.
Access the full on-demand educational webinar and explore additional clinician-focused resources, including research articles, procedural videos, and expert-led education inside the APEX Resource Library.
Watch the full webinar on-demand:
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References
1. Gupta, A. Autologous protein solution (APS) and osteoarthritis of of the knee: a scoping review of current clinical evidence. Cureus. 2024;16(2):e53579. doi:10.7759/cureus.53579
2. Fangzhou, C., et al. Clinical outcomes and magnetic resonance imaging evaluation of autologous protein solution treatment for knee osteoarthritis. Cureus. 2025;17(5):e84698. doi:10.7759/cureus.84698
3. Fukawa, T., et al. Safety and efficacy of intra-articular injection of platelet-rich plasma in patients with ankle osteoarthritis. Foot Ankle Int. 2017;38(6):596-604. doi:10.1177/1071100717700377
4. Repetto, I., et al. Conservative treatment of ankle osteoarthritis: can platelet-rich plasma effectively postpone surgery? J Foot Ankle Surg. 2017;56(2):362-365. doi:10.1053/j.jfas.2016.11.015
5. Hohmann, E., et al. Platelet-rich plasma versus corticosteroids for the treatment of plantar fasciitis: a systematic review and meta-analysis. Am J Sports Med. 2021;49(5):1381-1393. doi:10.1177/0363546520937293
6. Hurley, E., et al. Platelet-rich plasma versus corticosteroids for plantar fasciitis: a systematic review of randomized controlled trials. Orthop J Sports Med. 2020;8(4):2325967120915704. doi:10.1177/2325967120915704
7. Mautner, K., et al. Outcomes after ultrasound-guided platelet-rich plasma injections for chronic tendinopathy: a multicenter, retrospective review. PM R. 2013;5(3):169-175. doi:10.1016/j.pmrj.2012.12.010
8. Blanco-Rivera, J., et al. Treatment of lateral ankle sprain with platelet rich plasma: a randomized clinical study. Foot Ankle Surg. 2020;26(7):750-754. doi:10.1016/j.fas.2019.09.004
9. Shirazi, Z. & Quirolgico, K. Efficacy of platelet rich plasma in athletes with sesamoid fractures: a case series. Int J Foot Ankle. 2023;7(1):077. doi:10.23937/2643-3885/1710077
10. Siclari, A., et al. A 24-month follow-up after treatment of hallux rigidus with resection arthroplasty in combination with a resorbable polymer-based implant and platelet-rich plasma. Foot Ankle Surg. 2018;24(5):389-393. doi:10.1016
This blog post is a summary of an educational webinar and is intended for informational purposes for healthcare professionals only. The perspectives shared reflect the clinical experience and opinions of the presenters and do not necessarily represent the views of APEX Biologix. This content is not medical advice and is not intended to establish a standard of care, diagnose, or recommend treatment for any individual patient. Clinicians should evaluate all therapies using independent clinical judgment, applicable regulations, and the most current available evidence.