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christine91943 christine91943

Has anyone had amniotic injection for plantar fasciitis treatment?

My boyfriend has planter fasciiis in his right foot. He just had a amniotic injection a few days ago. Has anyone done this and did it help?

24 Replies

  • leigh1973 leigh1973 christine91943

    I just had this done today so I just wanted to say good luck. There's such limited info on this out there, but my podiatrist seemed to really have great things to say about it, so I'm hoping for the best. I'm just so sick of being in pain and want to get back to running ASAP!

    • Sorefoot1 Sorefoot1 leigh1973

      Hi, I was wondering how you have been doing after the ammiotic membrance injection for your plantar fasciitis.  I had the shot 4 wks. ago in my right foot and the pain has been worse than before the shot.  Doctor said it should be better soon, although I am not so sure.  The pain of the shot itself was horrific for me and I am worried that this entire idea was ill advised.  I couldn't afford the stem cell shot so I was hoping this less expensive one would work.   Will appreciate hearing from you.

  • ebh2403 ebh2403 christine91943

    Hi Christine,  

    I don't know much about this but have definitely heard of it and know that many doctors are huge believers in its success--particularly with PF.  Stem Cell Therapy, Amniotic Membrane Treatment and/or Platelet Rich Plasma (PRP) all fall under the "Regnerative Medicine" category.   

     

  • lws lws christine91943

    Can anyone tell me what success you had with the injections? My doctor office just called and left a recorded message about the injections. I have been dealing with Plantar Fasciitis for over a year in both feet. I have to take anti inflammatory medications and pain medication at times. I'm on my feet all day and tired of dealing with the pain. I can't exercise anymore and I want to get back to the gym and walk/run again. It can be debilitating and restricts the amount of activity I can do. I'm a very active person but I can't get rid of the pain. I have spent money on everything to treat and relieve dealing with the pain. Would love to hear any success with the injections.

  • matthew66773 matthew66773 christine91943

    Yesterday I had 50mg of Amniox's Clarix Flo injected into each of my feet. Since this is a relatively new technique for dealing with chronic plantar fasciitis there is not a large literature or online discussion out there. I will share with you my history, what I've thus far discovered about amniotic injections and I will follow up with you as time goes by. Hopefully I can help others make a more informed decision as they deal with this ridiculously persistent and terribly uncomfortable affliction.

    My History

    TL;DR: I've had plantar fasciitis for 13 years and tried just about every kind of conservative intervention imaginable. Nothing has worked.

    The long version:

    I’ve had plantar fasciitis (properly, plantar fasciosis) since 2004. I did it to myself in two ways: 1) I was a letter carrier wearing bad shoes for a couple years; and 2) one day I foolishly engaged in somewhat strenuous physical activity barefoot and on a concrete surface. The combination of these two lead to an uncomfortable burning tightness in both of my heels that I could not shake.

    I first tried inserts to support my arches. This helped somewhat. I tried the calf stretch on a stair which provided temporary relief. But I mostly just dealt with the pain until 2006 when I first visited a podiatrist. The podiatrist had custom foam-box-cast orthotics made for me. However, the orthotics made the problem worse and indeed the self-made inserts that I was producing on my own in my basement at the time provided more support and comfort than the $600 custom-made slices of plastic I got from the podiatrist. Being a young, stubborn and irreverent kid I never returned to the podiatrist.

    Shortly after that I was without insurance. I bought all manner of devices and contraptions (if you can find it on the internet I’ve tried it), tried every stretch imaginable, ingested strange substances I read about on message boards, and went through dozens of shoes looking for one that wouldn’t cause too much pain. I have no idea how much I’ve spent through it all but It is easily in the thousands. Maybe not five figures but probably not too far off.

    I was back on employer-provided insurance in 2014. Shortly after I made an appointment with a physical therapist who used the Graston technique. I visited her maybe seven times and eventually she just gave up. She told me that she had never seen feet as bad as mine and that I needed to see a podiatrist. She made a recommendation and I made an appointment.

    My hope was that I could convince this second podiatrist to perform a microdebridement procedure on me. You can google this if you are not familiar. He was open to this and we began to work out a plan but in the meantime he suggested corticosteroid, which I refused (and will never consent to. Again, google is your friend) and custom orthotics. For several reasons this podiatrist did not inspire confidence in me and after three visits I stopped scheduling appointments. I am not as young today but I am still quite stubborn and perhaps even more irreverent.

    I continued with my stretches and inserts and whatever else for about a year. However over this year my condition began to get much worse. While I’d had PF for some time it never got as bad as I hear some people have it. Over this year it began to get that bad.

    So I went to see a third podiatrist. For all sorts of reasons he is truly excellent. We tried a few things and didn’t see much improvement so he set me up with a (different) PT that he highly recommended. After an MRI which confirmed the PF diagnosis I went for 12 sessions of ASTYM. While ASTYM did not cure me it was easily the most effective treatment I’ve had thus far. For the record I do not consider my experience a data point in any ASTYM vs. Graston debate; I chalk up the difference that I’ve experienced to the competency of the people wielding the tools. After seeing this second PT it became very clear to me that the first was basically incompetent. The second was not.

    Anyway a combination of PT, certain stretches, religious use of frozen water bottles and golf balls did help things quite a bit. For a time I thought that I was on the road to recovery. And then, like everything else I’ve tried returns began to diminish. By the end of the 12 sessions I was basically back where I started. The PT said that as I adjusted to the orthotics the third podiatrist had recently made for me (from a plaster cast, which is the way to go) I would again see substantial improvement. Sadly this improvement did not come.

    So, back to the podiatrist. He said that he’d perform a fasciectomy if I want it (NOT a fasciotomy. Fasciectomy removes a pinky-sized portion of the fascia whereas a fasciotomy is just a small cut in the fascial band. The problem with fasciotomy is that the band can reconnect, scar over and then you’re back where you started. This is the chief reason why so many release procedures fail. My podiatrist regularly sees people who had their fasciotomy performed by other podiatrists and he ends up cutting them open again to do the fasciectomy). However the podiatrist recommended that we try one last more conservative intervention before that. And that’s where we get to amniotic injections.

    In a second post I will share with you what I’ve discovered about amniotic injections.

  • matthew66773 matthew66773 christine91943

    What I’ve Discovered About Amniotic Injections

    There is not a huge literature out there on amniotic injections, but what does exist is quite encouraging. Also, be advised, at least with Clarix Flo, these are adult stem cells, NOT embryonic stem cells. The ethical issues we hear about with stem cells are not present here.

    Anyway, here’s what I could find:

    1) An abstract of a huge meta-analysis in the British Journal of Sports Medicine:

     22 randomized control trials and 1216 patients. Amniotic membrane injections, Botox and saline. Results: 

    “We included 22 trials comprising 1216 patients. Dehydrated amniotic membrane injections were significantly superior to corticosteroids in the short term in achieving the primary and composite outcomes (mean difference (MD) in visual analogue scale (VAS) was −7.32, 95% CIs −11.2 to −3.38; and MD in the foot health status questionnaire was 31.2, 95% CIs 13.9 to 48.6, respectively). For pain relief, botulinum toxin-A provided a significant short-term advantage over placebo, which was still present at 6 months (MD in VAS was −2.9, 95% CIs −4.44 to −1.39; and MD −4.34, 95% CIs −7.18 to −1.54, respectively).”

    They had no data beyond two months for the amniotic injections but this is a huge and very encouraging analysis.

    2) An uncontrolled trial using Amniotic membrane/fluid injections for plantar fasciosis and achillies tendinosis:

    44 patients. Results:

    “For patients experiencing plantar fasciosis there was a significant improvement in pain scores in all patients by postoperative week four (, Figure 1), with a mean pain score of 5.2 (Table 1) indicative of moderate pain. By postoperative week 10 the pain scores were markedly reduced (, Figure 1) and the average self-reported scores indicated that the majority of patients experienced only mild pain.

    “Similar results were observed in patients experiencing Achilles tendinosis, and all patients gave self-reported pain scores not higher than moderate pain by postoperative week 6, with an average pain score of 4.7 (Table 1) ranging from 1 to 6 (Figure 2). By 12 weeks after treatment the average pain score had reduced to only 2.3 (Table 1) indicating that the majority of patients were experiencing mild pain. Therefore, after treatment with granulized amniotic membrane and amniotic fluid pain was significantly reduced compared to preoperative pain, with the majority of patients reporting only mild pain.”

    3) Amniox paid for a study on Clarix Flo that made the financial news:

    I cannot find the actual study or even an abstract but I did come across a power point put together by the lead researchers:

    It is encouraging.

    4) A randomized control trial with amniotic fluid/membrane injections against placebo:

    45 patients. Results:

    “Significant improvement in plantar fasciitis symptoms was observed in patients receiving 0.5 cc or 1.25 cc mDHACM versus controls within 1 week of treatment and throughout the study period. At 1 week, American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot scores increased by a mean of 2.2 ± 17.4 points for controls versus 38.7 ± 11.4 points for those receiving 0.5 cc mDHACM (P < .001) and 33.7 ± 14.0 points for those receiving 1.25 cc mDHACM (P < .001). By week 8 AOFAS Hindfoot scores increased by a mean of 12.9 ± 16.9 points for controls versus 51.6 ± 10.1 and 53.3 ± 9.4 for those receiving 0.5 cc and 1.25 cc mDHACM, respectively (both P < .001). No significant difference in treatment response was observed in patients receiving 0.5 cc versus 1.25 cc mDHACM.”

    The findings somewhat conflict with the Amniox study linked above. In the Amniox study improvement positively correlates with the size of the injection. Not so here. 

    5) An abstract of a randomized, controlled, double blind study with amniotic fluid/membrane against corticosteroid:

    Very small sample size. Results:

    “Three patients in each group received second injections. With the numbers available, the majority of outcome measurements showed no statistical difference between groups. The corticosteroid did, however, have greater FHSQ shoe fit improvement (P = .0244) at 6 weeks, FHSQ general health improvement (P = .0132) at 6 weeks, and verbally reported improvement (P = .041) at 12 weeks in the one-injection cohort. Cryopreserved hAM had greater FHSQ foot pain improvement (P = .0113) at 18 weeks in the 2-injection cohort.”

    ______________________

     All in all this literature inspired confidence. The last study is a bit of an outlier but I think there are some funny things going on there. I went ahead and scheduled the Clarix Flo injections even though it would cost me $850 of my own money. I had the injections performed 9/10/17. The podiatrist used a 25 gauge needle and suspended the medicine in sterile water. No anesthetic. It hurt worse than ASTYM and Graston, but wasn’t that big of a deal.

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  • matthew66773 matthew66773 christine91943

    Follow-Up

    I will continue to follow-up on this board, good, bad or indifferent. One thing that is very frustrating is that people typically do not follow-up after posting. One can assume this means that everything went well, but maybe not. Again I hope that by sharing my experience I can help others make more informed choices.

    As of 24 hours after the injections my heels are extremely tender. About 10 hours afterward I couldn’t even touch my finger to either heel without pain. The pain was not so bad that I wasn’t able to sleep with my night splints, but I still cannot put weight on either heel. The pain is becoming less acute today. I cannot feel any of the typical PF pain but then it very well may be masked by the acute pain of the injections. I did get a massive inflammatory response in both heels and this was expected. The swelling is still present at 24 hours.

    If I do not see a significant improvement at the six week mark my podiatrist will perform the release on both feet. For insurance purposes I want to get everything squared away by the end of this year (2017). Again I will update this thread as I move forward.

    • matthew66773 matthew66773

      One Week Follow-Up

      Over the first three days I was unable to put weight on either heel. Each saw a massive inflammatory response and a tremendous amount of acute pain at the insertion of the fascia. The acute pain, while still present at a week, has now receded to the point where I can once again walk normally. I do not know if this response is typical of all injections (e.g. corticosteroids) in all patients, if this is particular to me, or if it is particular to this specific medicine.

      Regardless I am still experiencing pain beyond the acute heel pain. In addition I have a substantial amount of inflammation throughout the bottom of each foot (I partially attribute the additional inflammation to two factors which are not directly related to the injections: 1) to compensate for the acute pain in each heel I walked around on my forefoot for almost a whole week; and 2) the way my foot has been resting in my night splints causes quite a bit of pressure on the forefoot. As I am now able to resume my normal gait and I have set aside the night splints for the time being I expect to see a change for the better in this regard. I have also returned to icing each foot every night and this has been helpful).

      So I think it is still too early to tell. Some days give reason for optimism, but others don't. I think that as the acute pain calms down I'll know much more. I am encouraged that over the last two or three days I've been feeling a deep itch in each heel, which is something I haven't felt in years. I am hopeful that in the presence of the stem cells healing is occurring without scar tissue formation. We'll see. 

      Anyway after having dealt with this malady for well over a decade, my body compensating in all sorts of ways, it is not surprising to me that it's not knocked out in a week. I'm sure this treatment will take some time and that my feet will have to adjust if it is effective. Such adjustment itself will take time and perhaps more than it would had I been dealing with this problem for only a year or six months. I am probably an atypical patient in this respect.

       

    • jrbecker jrbecker matthew66773

      Matthew,

      Thanks for the thorough update. As you have surmised, I suspect it might be too early to tell. I hope you positive signs continue to materialize.

      By the way, I'm surprised your doctor did injections in both feet at once. Mine had advised me to do one at a time and do use a walking boot for the first week after each the injection to let it "set." I can imagine how you'd have some compensatory pain after trying to manage ambulation after being injected in both feet.

    • matthew66773 matthew66773 jrbecker

      Right. I can say that, now that I know what I know, I would elect to split it up. I initially decided to do both at once to save money (for whatever reason using 100mg for two shots was cheaper than two 50mg doses. Plus there's the cost of the additional office visit, etc).

      Good luck with your procedure jrbecker. There's very good reason to be optimistic. Please do keep us updated. 

    • matthew66773 matthew66773

      Two Week Follow-Up

      At two weeks the acute pain from the shots has diminished to 10% of what it was in the 24 hours after the injections. I can now walk without piercing pain and I feel the pain from the shots only when I put lateral pressure on my heel or push into the insertion point of the central band of the fascia (the very bottom of the heel) with my thumb.

      But unfortunately, while some days are better I do not think the amniotic injections have worked for me. My job requires me to be on my feet lecturing for three hours at a time and by the end of the day on Thursday I continue to be in as much pain, if not more, as I have been every Thursday afternoon over the last few years. I remain hopeful that this treatment will work itself out over time but given my investigation into the literature I suspect that if I was going to see a significant response I would have seen more positive signs by now. My strong suspicion is that my feet are really screwed up from years of fasciopathy and that there is just a lot of stuff to undo before I can get better. It seems unlikely that I’m just missing that one silver bullet which can finally lock all the other stuff (stretching, ice, inserts, etc, etc) into place so that my feet can finally heal.

      Nevertheless, we’ll see what happens moving forward. I have a couple of weeks before an official follow-up visit with my podiatrist and I want to give it another month from today before I make any commitments to additional therapies and treatment protocols.

    • matthew66773 matthew66773

      Two Week Follow-Up

      At two weeks the acute pain from the shots has diminished to 10% of what it was in the 24 hours after the injections. I can now walk without piercing pain and I feel the pain from the shots only when I put lateral pressure on my heel or push into the insertion point of the central band of the fascia (the very bottom of the heel) with my thumb.

      But unfortunately, while some days are better I do not think the amniotic injections have worked for me. My job requires me to be on my feet lecturing for three hours at a time and by the end of the day on Thursday I continue to be in as much pain, if not more, as I have been every Thursday afternoon over the last few years. I remain hopeful that this treatment will work itself out over time but given my investigation into the literature I suspect that if I was going to see a significant response I would have seen more positive signs by now. My strong suspicion is that my feet are really screwed up from years of fasciopathy and that there is just a lot of stuff to undo before I can get better. It seems unlikely that I’m just missing that one silver bullet which can finally lock all the other stuff (stretching, ice, inserts, etc, etc) into place so that my feet can finally heal.

      Nevertheless, we’ll see what happens moving forward. I have a couple of weeks before an official follow-up visit with my podiatrist and I want to give it another month from today before I make any commitments to additional therapies and treatment protocols.

    • jrbecker jrbecker matthew66773

      Matthew,

      I'm really sorry to hear that you haven't had any improvement.  Hopefully some progress will still be made in the weeks to come (2 weeks is still somewhat early). 

      Like you, I've had a very intractable bilateral case of plantar fasciitis combined with plantar fibroma.  I have my doubts that the amniotic graft will have much impact but it's been suggested as a viable option by several docs. Given there's really no long-term adverse effects and with very few low-risk options available, I thought I should give it a try, especially since my insurance covers the majority of the cost.  Today (Sept 29), I will be getting the Amniox FLO injection in my left foot. I will be using a walking boot for the first week or so and I expect there to be some residual pain for the first couple of weeks. I plan to provide updates on my progress. 

    • matthew66773 matthew66773 jrbecker

      Yes, two weeks is still awfully early. After a follow-up email my podiatrist said that I should expect to see improvement at 4-6 weeks.

      I do have some good news: during the break in class on Tuesday evening, when I am usually hurting badly, I realized "hey, my feet don't hurt right now!" I can't remember the last time that happened.

      Indeed the entire week was an improvement. I usually top out at maybe a seven but this week I was at a five or at most a six at the worst moments. What's more, once I got off my feet I felt better much more quickly than normal. I am hopeful that this turns into a trend. 

      I wish you all the best today and afterward, jrbecker. Let's hope this is the beginning of the end for us both!

       

    • jrbecker jrbecker matthew66773

      Thanks, Matthew.

      Not much to report in the first 5 days since the injection.  I received a 25 mg injection that was divided into two problem areas along the arch in my left foot.  My doc wants me to wear a walking boot for the first week to help me stay off of it.  There was only some minor increased pain from the injection. Each day has gotten better in that regard.  And today (day 5), I'm almost back to my baseline level of usual discomfort. So obviously no decrease in overall pain yet, which is to be expected at this early juncture.  Keeping my fingers crossed.   My other foot (the right) does seem to be hurting a bit more than usual probably because I'm overcompensating.  

      Hoping to hear of further progress on your end. 

    • matthew66773 matthew66773

      Week Four Follow-Up

      In a previous response to jrbecker I wrote that I was experiencing some relief. This was at the beginning of the third week after receiving the amniotic injections. Sadly this relief did not last more than a few days; the past week has been very similar to the many weeks prior to the injections and I am experiencing very little to no change in my condition. 

      I had a follow-up with my podiatrist yesterday and we both think waiting another month is prudent. We also agreed to tentatively schedule a fasciectomy for the right foot on 11/17. If my condition improves significantly over the next month then I will of course cancel the procedure, but if not we'll be ready to go. We are planning on doing the left foot sometime in the middle of December.

    • matthew66773 matthew66773

      Two Month Follow-Up

      No significant change to report regarding the efficacy of stem cell therapy. Both feet still hurt. I do notice, however, a positive change in recovery time. Prior to the stem cells it took a little bit longer than it does now to be back to a relatively pain-free state after getting off my feet. So that's something.

      Anyway I have a plantar fasciectomy for my right foot scheduled for 11/17. The left foot is scheduled for 12/15.

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