Can Amniotic Tissue Injections Get Patients With Plantar Fasciitis Back Up and Running?

For me, running is freedom. Running is life. When I run, I do all my best thinking.

I’ve been running marathons since February of 2013; my last was the LA Marathon in March 2020, just before the pandemic. If it’s warmer than 40 degrees, I’m out there, six to seven days a week. Running is critical to my health and mental wellbeing. I’m sure I’m not alone in this respect.

In Atlanta, I started Run Zero 2 Hero to provide distance-running programs so participants can unlock their full potential. I coach 37 runners, beginning and advanced, ranging in age from 10-year-old second-graders to runners 60-plus. Running inspires them; it’s a central part of their lives. And when our people can’t run due to pain, they lose freedom and the perspective that comes with it.

I’m also a podiatrist. When a patient comes into our practice, Atlanta Sports Podiatry, with heel pain, I want to find out all that I can. I want to know what brought them to me that day, what level of pain they are feeling and if their body is functioning properly. If my patients are runners, the question often is, “after treatment, will the issue return?”

One of the first things I do is look at my patients’ running shoes to examine their wear pattern. Are they changing them often enough? Are they using the right shoe, and are they getting them from a running store or sight unseen, online? If they’re an athlete, I want to film their running form on an iPad; if they’re heel-striking, they may be prone to relapse due to increased ground reactive forces in the heel. I also look at balance testing to determine if they have weakness in their glutes or core. That can result in plantar fasciitis, Achilles tendonitis or shin splints.

Often, the pain is due to plantar fasciitis. Pain typically comes on gradually and for me, it felt like a sudden sharp tear.

If I believe a patient has plantar fasciitis, I’ll want to rule out stress fractures, bone tumors, posterior tibial tendonitis, or referred spinal nerve pain (all of which can mimic plantar fasciitis) and then determine a treatment plan. If their pain level is seven or less on a numeric rating scale, I’m more likely to employ shockwave therapy; often, I find my patients can run right after getting these treatments. If pain is extreme, I personally go with a regenerative medicine approach using an amniotic tissue injection.

The product I use is derived from amniotic tissue gathered from placentas donated by women after planned C-sections. It’s shelf-stable, shipped to us in a vial, and we add saline to reconstitute it and administer through injection. The amniotic tissue possesses roughly 226 different growth factors,¹ and it's a single shot; in our experience, it's rare that we ever have to administer more than one injection.

Once injected, the body's own stem cells come to the area, and that's when we see this innovative treatment really start to work. I've been doing this now for over eight years, and we typically see results in anywhere from five to 14 days on average, with patients using a walking boot. Patients ice the affected area until pain levels subside. In 14 days or less, our observation is that our patients are up and – quite literally – running.

In response to the debilitating pain of my own plantar fasciitis, I’ve had injections in both heels at different times. After getting plantar fasciitis the second time, I ran the Knoxville Marathon nine days after injection. My wife was waiting at the halfway point. “How’s your foot?” she shouted out.  “Perfect.”  I haven’t felt pain since. That was three years ago.

Injection technique is simple. I press on the area that hurts most and mark an ‘X,’ I always numb the foot and then, two minutes later, I prepare the amniotic tissue injection and inject directly into the location of the pain. That’s what I recommend because I don’t find that the medicine spreads too well over a larger area.

Some use injectable corticosteroids for plantar fasciitis. The reason I don’t believe in using it is the plantar fascia has a very poor blood supply. The plantar fascia is a thickened aponeurosis. If you inject it with a corticosteroid, it has the potential to calcify and rupture², so caution must be taken.

I stress physical therapy post-injection, sharing information on toe yoga and demonstrating foot-strengthening exercises. Strengthening the foot may decrease risk of plantar fasciitis. If I see weak glutes or core, I go over pre-exercise dynamic stretches and a strength training program that consists of walking lunges, air squats and planks, in addition to others.

While I employ it based on high pain levels, if it were up to me, more patients with plantar fasciitis in my practice would get amniotic tissue injection.  It’s the best way I have found, with sound predictability, to get my patients back up and running.

Dr. Spector is a Fellow and current Vice President of the American Academy of Podiatric Sports Medicine. He is an RRCA  and USATF Certified Running Coach and in practice in Johns Creek, Ga. Dr. Spector can be found at www.atlantasportspodiatry.com.

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References

1. Lei J, Priddy LB, Lim JJ, Koob TJ. Dehydrated human amnion/chorion membrane (dHACM) allografts as a therapy for orthopedic tissue repair. Tech Orthop. 2017;32(3):149-157.

2. Lee HS, Choi YR, Kim SW, Lee JY, Seo JH, Jeong JJ. Risk factors affecting chronic rupture of the plantar fascia. Foot Ankle Int. 2014;35(3):258-263.