Aetna's clinical policy bulletin governing medical necessity, investigational status, coding, and limitations for treatments of plantar fasciitis for Aetna members.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.
last review date
Coverage and Medical Necessity Criteria
Combined steroid/anesthetic injection — medical necessity
Covered when ALL of the following are met:
Combined steroid/anesthetic injection criteria: Combined steroid/anesthetic injection is medically necessary for treatment of the plantar fascia when conservative treatments (eg, stretching exercises, over-the-counter silicone heel shoe inserts, and 2 to 3 weeks of non-steroidal anti-inflammatory drugs) have failed.failure of conservative treatments
Conservative treatments examples listed in policy
Endoscopic plantar fasciotomy — medical necessity
Covered when ALL of the following are met:
Endoscopic plantar fasciotomy criteria: Endoscopic plantar fasciotomy is medically necessary as an alternative to conventional open plantar fasciotomy for members with intractable plantar fasciitis or heel spur syndrome who have failed a 6-month trial of conservative therapy.6-month failed conservative therapy
Intractable plantar fasciitis or heel spur syndrome required
Evidence-informed coverage considerations
Evidence-based considerations and common study eligibility criteria that would inform coverage:
Common inclusion/clinical prerequisites: Clinical and radiologic diagnosis of plantar fasciitis with symptom duration commonly >= 6 months; prior failure of conservative therapy documented.duration >= 6 months
Derived from trial eligibility and study descriptions
Evidence strength for specific modalities: Randomized, double-blind, high-quality trials often show no benefit for ESWT overall; some trials (eg, Gerdesmeyer 2008) and meta-analyses report benefit for radial/low-intensity ESWT but evidence is heterogeneous and quality-dependent.quality-dependent
CTAF and systematic reviews highlight variability in study quality and potential publication bias
Intervention-specific evidence summaries
Summaries of the evidence for specific treatments and their observed effectiveness:
mDHACM (micronized dehydrated human amniotic/chorionic membrane) injections: A single-center randomized feasibility trial (n=45) reported significant short-term improvements in pain and function versus saline control for 0.5 cc and 1.25 cc mDHACM; authors noted larger studies are needed to confirm findings.
Feasibility trial; short follow-up
Extracorporeal shock wave therapy (ESWT): Meta-analyses and pooled trials report low-intensity or radial ESWT can be superior to placebo for short-term pain relief and function (eg, Gerdesmeyer 2008; Yin et al. meta-analysis), but study heterogeneity and inconsistent trial quality limit certainty about long-term benefit.
Autologous growth factor injections (PRP/whole blood): Systematic reviews and RCTs show conflicting and heterogeneous results: several higher-quality studies found no improvement versus control, whereas some pooled analyses suggest PRP may provide greater pain relief at longer follow-up (eg, 24 weeks); variability in preparation and small sample sizes limit generalizability.
Evidence-based coverage considerations (no formal coverage rules in excerpt)
Evidence-summary style coverage considerations based on the extracted studies:
General evidence and patient selection: Studies generally enrolled patients with chronic plantar fasciitis refractory to conservative therapy; many required symptom duration >6 weeks to >6 months and failure of analgesics and physical therapy.symptom duration commonly >6 weeks (some studies >6 months)
Exact requirements vary by study and are not standardized in this document.
PRP vs corticosteroid/PPP outcomes: Meta-analyses and RCTs show mixed results: some pooled analyses found PRP superior to corticosteroid for pain relief at 24 weeks, while individual RCTs found no difference between PRP and PPP; heterogeneity and limited high-quality evidence constrain confidence.long-term benefit (>=24 weeks) more likely with PRP in some analyses
Preparation variability and small sample sizes are key limitations.
ESWT and shock wave therapies:
Use in refractory plantar fasciitis (evidence‑based considerations)
Summary of evidence‑based stance and decision logic inferred from cited literature
Base criteria for considering limited‑evidence or investigational therapies: Patient has clinical diagnosis of plantar fasciitis; symptoms refractory to an adequate course of conservative management (eg, stretching, physical therapy, orthoses, NSAIDs) documented; informed consent about limited evidence and alternatives is obtained; procedure is performed by trained clinician under appropriate imaging/guidance when applicable.documented failure of conservative care (varies by study; e.g., >3 months)
Multiple studies enrolled patients after failure of conservative care and authors recommend reserving these modalities for refractory cases.
Evidence summaries for individual treatment modalities
Evidence summaries and outcomes for specific modalities (no definitive coverage criteria stated in this excerpt).
High-Intensity Laser Therapy (HILT): Randomized trials did not show statistically significant benefit of HILT over conservative physiotherapeutic procedures; authors concluded HILT cannot currently be recommended for pain management in plantar fasciitis/calcaneal spurs.
See cited RCT results
Hyaluronic Acid injection: A randomized trial protocol comparing single US-guided HA injection versus ESWT is described (results pending); outcomes to include VAS, AOFAS, FAOS at baseline and 3, 6, 12 months.
Protocol published; results pending
Manual therapy informed by Fascial Distortion Model (FDM): Single-arm prospective study (n=28 treated) reported improvements in validated foot pain and function scores and decreased plantar fascia thickness at 16 weeks; authors call for corroboration in larger RCTs.
Preliminary single-arm data
Aetna considers a broad set of procedures and modalities experimental or investigational for the treatment of plantar fasciitis due to insufficient or inconsistent evidence of safety and effectiveness. Examples listed in the policy include: local ozone (O2–O3) injection, low‑level laser therapy, fascial distortion model–informed manual therapy, marrow stimulation techniques, micronized dehydrated amniotic/chorionic membrane allograft, neural therapy, neurolysis (combined alcohol/Marcaine), perforating fat injection, piezoelectric focal wave application, ultrasonic‑guided partial plantar fascia release, platelet‑rich plasma/platelet‑poor plasma/growth factor injections, proximal trigger point release, pulsed radiofrequency, radiofrequency lesioning, radiotherapy, TENEX/TenJet procedures, transcranial direct current stimulation, trigger point dry needling, and therapeutic ultrasound. These approaches are listed as exclusions where the evidence base is inadequate to support routine coverage.
The policy notes that heel cushions/pads, night splints, shoe modifications, and orthopedic shoes are not covered under benefit plans that exclude orthopedic shoes, foot orthotics, or other supportive foot devices. Members and providers should consult individual benefit plan documents to determine whether these items are a covered benefit, because coverage is determined by the member’s plan terms rather than this clinical policy.
The California Technology Assessment Forum (CTAF) assessment concluded that randomized trials of extracorporeal shock wave therapy (ESWT) for plantar fasciitis show variable quality and inconsistent results; fair to poor quality studies tended to report benefit while several higher‑quality trials did not. CTAF therefore stated that ESWT should remain investigational until unequivocal benefit is consistently demonstrated in high‑quality trials.
UpToDate and review summaries identify several interventions for plantar fasciitis as unproven or experimental. These include autologous whole blood/PRP injections, botulinum toxin injection, cryosurgery, extracorporeal shock wave therapy (ESWT), low‑level laser therapy, and radiotherapy; therapeutic ultrasound also failed to show added benefit in a randomized trial and is recommended by some authors to be excluded from routine treatment.
Multiple reviews and clinical summaries list a similar set of interventions as lacking sufficient evidence for routine use in plantar fasciitis. Specifically, authors and UpToDate identify PRP/whole‑blood injections, ESWT, botulinum toxin, cryosurgery, low‑level laser therapy, and radiotherapy among therapies considered unproven; acupuncture is also noted to have only limited short‑term evidence and is not broadly supported for long‑term effectiveness.
The National Institute for Health and Clinical Excellence (NICE) reviewed autologous blood injection for plantar fasciitis and concluded that the evidence on efficacy is inadequate in quantity and quality. NICE therefore recommended that autologous blood injection should be used only with special arrangements for clinical governance, consent and audit or in research settings, and encouraged further well‑conducted trials describing patient selection and outcomes.
A randomized trial of high‑intensity laser therapy (HILT) cited in the policy found no statistically significant benefit versus standard conservative physiotherapeutic procedures for pain measures, leading the authors to conclude that HILT cannot currently be recommended as superior to conservative treatment for plantar fasciitis/heel spurs.
UpToDate’s contemporary review of plantar fasciitis does not list combined alcohol/Marcaine neurolysis as a therapeutic option. The omission indicates that this combined neurolytic injection approach is not recognized in that guideline summary and lacks endorsement as a recommended therapy.
ARPwave Neuro‑Therapy, a modality that applies low‑voltage electrical currents to injury sites, is not mentioned in UpToDate and the policy notes a lack of supporting evidence for its effectiveness in plantar fasciitis, indicating a high risk of denial when billed absent stronger evidence.
Extracorporeal shock wave therapy (ESWT) and several other modalities are characterized in the evidence summaries as unproven or experimental for plantar fasciitis because high‑quality, sham‑controlled trials give inconsistent results and meta‑analyses identify significant heterogeneity and potential publication bias. The policy and supporting systematic reviews therefore treat ESWT and other variably studied interventions as insufficiently established for routine coverage.
The CTAF meta‑analysis highlighted that trial quality was strongly associated with observed benefit for ESWT, with many small, inadequately blinded trials showing positive findings while better‑conducted studies did not. CTAF concluded that the overall literature does not provide convergent high‑quality evidence to support routine use of ESWT for plantar fasciitis.
Systematic reviews of autologous growth factor injections (PRP/whole blood) report heterogeneous findings; higher‑quality studies generally do not show improvement in pain or function compared with controls, and the lack of standardized preparation and protocol means that current evidence does not robustly support autologous growth factor injections for plantar fasciopathy.
The policy emphasizes an evidence‑quality caveat: many studies across modalities have small sample sizes, heterogeneous protocols, and variable risk of bias. This limits confidence in pooled estimates and constrains the ability to make firm coverage determinations for numerous emerging interventions.
Trials of hyaluronic acid injections and high‑intensity laser therapy cited in the policy do not currently demonstrate superiority over conservative care. Specifically, the HILT randomized trial showed no greater pain benefit than standard physiotherapeutic procedures, supporting the statement that Hyaluronic acid and HILT lack convincing evidence of superiority at present.
The policy restates that high‑intensity laser therapy did not show benefit over conservative physiotherapeutic treatment in the cited randomized trial and therefore cannot be recommended as a superior pain management option for plantar fasciitis/heel spurs based on current evidence.
Coding — Affected CPT/HCPCS/ICD-10
CPT codes covered if selection criteria are metCPTCovered
20550
Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia").
29893
Endoscopic plantar fasciotomy.
CPT codes not covered for indications listed in the CPBCPTNot Covered
0232T
Injection(s), platelet rich plasma, any tissue, including image guidance, harvesting and preparation when performed.
0481T
Injection(s), autologous white blood cell concentrate (autologous protein solution), any site, including image guidance, harvesting and preparation, when performed.
20552
Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s).
20553
Injection(s); single or multiple trigger point(s), 3 or more muscle(s).
20560
Needle insertion(s) without injection(s); 1 or 2 muscle(s) [dry needling].
Osteotomy; calcaneus (eg, Dwyer or Chambers type procedure), with or without internal fixation.
28890
Extracorporeal shock wave, high energy, performed by a physician or other qualified healthcare professional, requiring anesthesia other than local, including ultrasound guidance, involving the plantar fascia.
64640
Destruction by neurolytic agent;
Other CPT codes related to the CPB / not covered for some indicationsCPTNot Covered
77401-77417
Radiation treatment delivery.
97035
Application of a modality to 1 or more areas; ultrasound, each 15 minutes.
97810-97814
Acupuncture without/with electrical stimulation.
28008
Fasciotomy, foot and/or toe [not covered when guided by ultrasonic energy].
28060
Fasciectomy, plantar fascia; partial (separate procedure) [not covered when guided by ultrasonic energy].
28062
Fasciectomy, radical (separate procedure) [not covered when guided by ultrasonic energy].
28250
Division of plantar fascia and muscle (eg, Steindler stripping) (separate procedure) [not covered when guided by ultrasonic energy].
HCPCS / Drug codes not covered for indications listed in the CPBHCPCSNot Covered
C9290
Injection, bupivacaine liposome, 1 mg.
E0761
Non-thermal pulsed high frequency radiowaves, high peak power electromagnetic energy treatment device.
E0769
Electrical stimulation or electromagnetic wound treatment device, not otherwise classified.
G6001-G6014
Radiation treatment delivery.
J0585
Injection, onabotulinumtoxinA, 1 unit.
J1030
Injection, methylprednisolone acetate, 40 mg.
P9020
Platelet rich plasma, each unit.
Q4139
Amniomatrix or biodmatrix, injectable, 1 cc.
S8948
Application of modality (requiring constant provider attendance) to one or more areas; low-level laser; each 15 minutes.
Other HCPCS codes related to the CPBHCPCS
A4570
Splint.
L3000-L3265
Orthopedic shoes.
L3300-L3649
Shoe modifications.
L4350-L4398
Splint, ankle, foot, leg.
ICD-10 codes covered if selection criteria are metICD-10Covered
M72.2
Plantar fascial fibromatosis.
M77.30-M77.32
Calcaneal spur.
Codes not specified in this segmentmixed
No codes listed
Conservative therapy duration before surgery — endoscopic plantar fasciotomy
Conservative therapy duration before endoscopic plantar fasciotomy6 months of failed conservative therapy required
Indication for procedureIntractable plantar fasciitis or heel spur syndrome after conservative trial
NSAID trial duration before injection
Recommended NSAID trial duration before steroid/anesthetic injection2 to 3 weeks of non-steroidal anti-inflammatory drugs (NSAIDs)
Provider Impact: Authorization, Documentation, and Billing
Prior Authorization
Prior Conservative Therapy
Prior conservative therapy generally required: Nonoperative measures should be documented and tried before advanced or procedural interventions. Typical conservative treatments include plantar and calf stretching programs, over‑the‑counter silicone heel inserts, and a trial of NSAIDs (2–3 weeks). For surgical interventions, a 6‑month trial of conservative therapy is generally expected.
Conservative-first approach: Attempt stretching/exercise and other conservative measures prior to adjunctive modalities.
Conservative therapy before advanced interventions: Studies and guidelines frequently require failed conservative care prior to enrollment or consideration of procedures.
Prior Authorization
Prior Authorization Recommended for Limited‑Evidence Interventions
Prior authorization recommended for limited‑evidence interventions: Procedures with limited, mixed, or evolving evidence should be subject to authorization review to ensure medical necessity and appropriate selection. Examples include minimally invasive procedures and novel biologic or placental‑derived products.
Background and Definitions
Across instrument‑assisted soft‑tissue mobilization (Graston/IASTM) studies and similar pilot trials, the evidence is limited and inconsistent; available randomized trials generally do not support clear efficacy, and authors call for larger, higher‑quality studies before these techniques can be endorsed for routine use.
Plantar fasciitis — definition
DefinitionTraction degeneration of the plantar fascia at its origin on the heel; most common cause of chronic heel pain.
Common causes/contributorsBone spurs or inflammation of the foot's connective tissue; condition may be resistant to conservative treatment.
Heterogeneous methods and mixed outcomes across studies
Cryo-preserved human amniotic membrane (c-hAM): Small randomized double-blind pilot found most outcomes similar to corticosteroid with some isolated subgroup/timepoint improvements; pilot nature limits conclusions and further study required.
Pilot RCT; limited evidence
Ultrasound therapy (therapeutic US): A randomized, double-blind, placebo-controlled trial (n=54) found no added benefit of therapeutic ultrasound when combined with stretching versus sham US plus stretching; investigators recommended excluding therapeutic US from treatment of plantar fasciitis.
Level 1b evidence showing no additive benefit
Other small/modality-specific studies (LED, tDCS, percutaneous techniques): Small randomized or pilot studies of LED, transcranial direct current stimulation, percutaneous ultrasonic-guided partial release/tenotomy and other emerging modalities report preliminary improvements in some measures, but sample sizes are small and results require validation in larger randomized trials.
Preliminary evidence; further validation needed
Systematic reviews/meta-analyses suggest focused shock wave therapy can relieve pain in chronic plantar fasciitis versus placebo; radial and general ESWT findings are mixed with significant heterogeneity across studies.
improvements observed up to follow-up durations reported (varies by study)
Additional trials needed to validate modality-specific effects.
Radiofrequency lesioning and thermal RF: Retrospective comparative studies report greater short- to mid-term pain improvement with radiofrequency lesioning compared with ESWT in some series, but evidence is limited (Level III) and randomized data are lacking.follow-up up to 6 months reported in comparative study
Dose and protocol optimization not established.
LLLT (low-level laser therapy): Systematic reviews/meta-analyses indicate LLLT may reduce pain and disability in short- to medium-term compared with placebo or as an add-on to exercise, but small heterogeneous trials limit conclusions and long-term outcomes are lacking.short- to medium-term benefit reported (eg, up to ~3 months)
Heterogeneous parameters and small trials limit conclusions.
Other emerging therapies (ozone, neural therapy, piezoelectric shock, Graston/IASTM, acupuncture): Small RCTs, case reports, and pilot studies report possible benefits for some modalities, but evidence is preliminary and insufficient for definitive coverage conclusions.mostly small sample sizes (n often <100) and short follow-up
Authors consistently call for larger, well-designed trials.
Neurolysis with alcohol/Marcaine ± partial plantar fasciectomy: Small surgical series reported satisfactory functional outcomes in many patients with recalcitrant plantar fasciitis after failed non-surgical therapy, but results are confounded by combined procedures and retrospective design.
Small case series with combined procedures
Perforating fat injection: Pilot randomized crossover trial reported reductions in plantar fascia thickness and improvements in pain and function in the injected group; findings are preliminary and require validation in larger studies.
Pilot study; Level II evidence reported
Proximal trigger point release / massage: Case reports and small series report symptomatic improvement after multimodal massage/trigger point release regimens, but results are confounded and insufficient for coverage conclusions.
Single-case or small series evidence
ARPwave Neuro-Therapy: Mechanism described (low-voltage electrical currents) but clinical effectiveness is not established and modality is not mentioned in UpToDate; evidence is lacking.
Insufficient evidence and guideline omission
Conservative measures to attempt prior to injectionStretching exercises and over-the-counter silicone heel shoe inserts
Coverage conditionCombined steroid/anesthetic injection medically necessary when conservative treatments have failed
Procedures warranting prior authorization review: Tenex/PUT (ultrasound‑guided percutaneous fasciotomy/tenotomy), ultrasound‑guided percutaneous fasciotomy, minimally invasive fasciotomy, and other limited‑evidence modalities.
Consider authorization requirement for biologic injections (mDHACM, cryo‑preserved amniotic membrane), autologous blood/PRP, and placental‑derived products.
Denial Risk
Experimental / Investigational — Denial Risk
Experimental / Investigational Denial Risk: Interventions lacking reliable published evidence are considered experimental/investigational and may be denied. Providers should expect denials for listed techniques unless robust supporting evidence and documented medical necessity are provided.
Examples currently listed as experimental/investigational: ARPwave Neuro‑Therapy, autologous blood/growth factor injection, cryo‑preserved human amniotic membrane injection, extracorporeal shock‑wave therapy (device‑specific), hyaluronic acid, and others.
NICE and other technology assessments recommend use only in research or with special arrangements for consent and audit.
Denial Risk
Evidence Variability May Trigger Investigational/Denial Stance
Evidence variability may trigger investigational/denial stance: Where trial quality and results are inconsistent (e.g., ESWT), payers may treat interventions as investigational until high‑quality, reproducible benefit is demonstrated.
ESWT example: Meta‑analyses and technology assessments note heterogeneity, publication bias, and conflicting RCT results; some positive small trials exist but good‑quality trials are often negative.
Documentation that higher‑quality evidence is lacking may support investigational determinations.
Note
Ultrasound Therapy Evidence
Ultrasound therapy evidence: Therapeutic ultrasound added to a structured stretching program did not demonstrate additional benefit versus sham ultrasound in a randomized, double‑blind trial. Document medical necessity if ultrasound is used as adjunctive therapy.
Katzap et al (2018): Both stretching+US and stretching+sham improved; no between‑group difference — do not routinely add therapeutic US.
If billed, include documentation of rationale and prior conservative care.
Note
Administrative/Authorization Contact Info — Not Provided Here
Not provided in this document segment: Specific operational prior authorization codes, forms, or contact routing for authorization requests are not listed in this section; contact your plan representative or portal for authorization submission details.
Administrative and contact information: See plan resources or Clinical Policy Bulletin notes for submission instructions and updates.
Denial Risk
ARPwave Neuro‑Therapy — Limited Evidence
ARPwave Neuro‑Therapy — limited evidence: ARPwave is listed among approaches with insufficient evidence. Expect investigational designation and potential denial for ARPwave without strong supporting clinical documentation or participation in research protocols.
ARPwave has limited published evidence and is not mentioned in standard clinical reviews (UpToDate).
If pursued, include detailed justification, prior conservative treatments, and outcome measures.
Note
No Specific Administrative Denial Triggers Specified Here
No denial triggers specified in this section: The policy history and background provide examples of investigational procedures but do not enumerate explicit administrative denial triggers beyond lack of reliable evidence. Use clinical judgment and plan rules when submitting.
Absence of explicit denial triggers: Reviewers will rely on experimental/investigational listings and evidence strength when adjudicating claims.
Documentation Required
Documentation Requirements and Suggested Clinical Data
Documentation of selection criteria: Coverage and authorization decisions depend on meeting documented selection criteria — include indication, chronicity, prior treatments, and trial outcomes as described in trials and assessments.
Symptom duration and diagnostic documentation: Note clinical and radiologic diagnosis and duration (many trials required ≥6 months or other defined chronicity).
Suggested documentation elements: Indication for treatment, duration of symptoms, prior conservative therapies tried (dates, modalities, responses), and reason for escalation.
Suggested clinical outcome documentation: Use validated outcome measures where available (VAS, AOFAS, FADI, FFI, FAOS, Foot and Ankle Ability Measure).
Surgical outcome documentation: Provide operative reports, indications showing failure of nonoperative care, and pre/post‑op outcome scores (e.g., Maryland Foot Score, VAS).
Imaging and PROs for injection therapies: Include ultrasound measures (plantar fascia thickness) and patient‑reported outcomes (VAS, AOFAS, FHSQ) when applicable.
Administrative/contact information: For policy updates, review dates, and bulletin notes, refer to the Clinical Policy Bulletin resources and plan contact channels.
Step Therapy
Stepwise Care and Refractory‑Case Considerations
Stepwise care and reserve for refractory cases: Many studies required prior failed conservative treatments (step therapy) before enrollment; newer or invasive modalities are generally reserved for refractory cases after stepwise escalation.
Step therapy noted in study enrollment criteria: Trials commonly required failed conservative treatments (e.g., ≥3 months structured rehab) before investigational procedures.
Reserve for refractory cases: Modalities such as PUT/TENEX, ESWT, RTL, and percutaneous interventions are typically considered after standard conservative measures fail.
No step therapy requirements are described: The policy does not list an explicit step‑therapy algorithm or specific timeframes beyond the examples noted; document prior care clearly.
A therapy that delivers shock waves to target tissue to disrupt scar tissue and induce neovascularization, potentially facilitating healing.
Device example and mechanismDornier EPOS Ultra uses electromagnetic energy and focused acoustic lens; typically ~3,800 shocks over 20 minutes with ultrasound monitoring.
Clinical contextUsed most recently for plantar fasciitis; intended to relieve pain by causing microscopic tissue damage and stimulating repair.
ESWT — device and energy level variability
ESWT — variability in devices and energy levelsStudies vary by energy level, device, and technique; no single device or protocol has been shown consistently superior.
Quality-dependent outcomesLower-quality trials often report benefit while higher-quality, well-blinded studies frequently do not; publication bias noted.
Focused vs radial distinctionsMeta-analyses separate focused (FSW) and radial (RSW) modalities; FSW may relieve pain, while overall ESWT/RSW findings are heterogeneous.
mDHACM — definition
mDHACM — termMicronized dehydrated human amniotic/chorionic membrane (mDHACM)
Form and useInjectable biologic studied in a small randomized single-center feasibility trial for chronic refractory plantar fasciitis (n=45).
Reported trial outcomesSignificant short-term improvements in pain and function versus saline control; authors recommend larger confirmatory studies.
PRP / autologous whole blood — variations and evidence
PRP / autologous whole blood — core conceptAutologous platelet-rich plasma (PRP) or whole-blood injections into the plantar fascia intended to stimulate healing.
Preparation variabilityVaries by volume of blood drawn, anticoagulant, centrifugation speed/time, leukocyte concentration, activation method, and final platelet/growth-factor concentrations.
Evidence summaryRCTs and meta-analyses show heterogeneous results: some analyses suggest PRP superior to steroid for longer-term pain (24 weeks), while other RCTs find no difference versus PPP or dry-needling.
ActiveMatrix — description
ActiveMatrix — descriptionA pre-mixed, ambient-temperature human placental connective tissue matrix intended to replace or supplement damaged integumental tissue.
Clinical noteActiveMatrix is not mentioned in the UpToDate review on plantar fasciitis referenced in the policy.
Status in policyListed among approaches considered experimental and investigational for plantar fasciitis.
PRP / PPP — descriptions
PRP vs PPP definitionsPRP = platelet-rich plasma; PPP = platelet-poor plasma/whole-blood preparations used as autologous biologic injections.
Preparation and technique heterogeneityPreparation methods, platelet and growth-factor concentrations, and injection techniques vary across studies and are not standardized.
Clinical evidenceMeta-analyses of RCTs show mixed results: some short-term equivalence with steroids but possible PRP superiority at longer follow-up; heterogeneity limits generalizability.
ESWT — focused and radial modalities
ESWT modalitiesIncludes focused shock wave (FSW) and radial shock wave (RSW) modalities used in chronic plantar fasciitis treatment studies.
Comparative findingsMeta-analyses report FSW may relieve pain; overall results vary with heterogeneity across RSW and general ESWT studies.
Clinical implicationsDevice-, energy-, and protocol-specific differences mean outcomes are not uniformly reproducible across studies.
Evidence summaryRCTs appraised showed insignificant differences versus controls for musculoskeletal pathologies; short-term ROM gains reported but overall efficacy not established.
Standardization gapNo consensus on optimal program, instrument type, dosage time, or outcome measures; further well-designed trials needed.
IASTM / Graston technique — alternate description
IASTM alternative descriptionManual therapy using hand-held instruments to mobilize soft tissue; protocols, instruments, dosage, and outcomes are not standardized in the literature.
Research needAuthors note a gap between research and clinical practice and call for fully powered controlled trials of IASTM protocols.
Clinical use notePopular in practice but efficacy not fully validated due to paucity and heterogeneity of evidence.
Percutaneous ultrasonic tenotomy (PUT) / Tenex
PUT / Tenex — descriptionPercutaneous ultrasonic tenotomy (PUT; Tenex/TENEX/TENJET) is a minimally invasive, device-assisted debridement/tenotomy using ultrasound or high‑velocity fluid to remove diseased tendon tissue.
Evidence baseLimited and primarily low-level evidence for plantar fasciitis; systematic review includes few studies with generally favorable short-term outcomes but long-term data lacking.
Clinical positioningConsidered for patients with tendinopathy refractory to conservative treatments; further higher-quality comparative studies needed.
Autologous blood injection (ABI) and RCT finding
Autologous blood injection (ABI) — definitionInjection of the patient’s own blood into the plantar fascia with intent to stimulate healing.
High-quality RCT outcomeA double-blinded RCT found no additional benefit of ABI compared to a dry-needling fenestration procedure; both groups improved over time.
Clinical implicationEvidence does not support ABI providing added effect over dry needling for chronic plantar fasciitis in the cited trial.
Fascial Distortion Model (FDM)
Fascial Distortion Model (FDM) — conceptA manual diagnostic and treatment strategy that identifies fascial 'distortions' based on patient pain patterns and palpation to deliver distortion-specific manual therapy.
Study evidenceProspective single-arm study reported improvements in validated foot pain and function scores and decreased plantar fascia thickness at 16 weeks, but rigorous RCTs are lacking.
Research recommendationAuthors call for corroboration in larger randomized controlled trials before definitive conclusions can be drawn.
ARPwave Neuro-Therapy — description
ARPwave Neuro-Therapy — descriptionA modality employing low-voltage electrical currents at the injury site to stimulate the nervous system, promote muscle relaxation, and encourage healing.
Evidence statusLacks supporting evidence for plantar fasciitis and is not mentioned in the UpToDate review; listed as experimental/investigational in the policy.
Coverage implicationMay be subject to denial as investigational due to insufficient published literature documenting safety and efficacy.