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?
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!
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.
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.
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.
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.
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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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.