Amniotic Injections for Foot & Ankle Arthritic Conditions

Amniotic products have been used successfully for over a century in the setting of problematic tissue healing and have enjoyed a stellar safety record. Following recent clinical success with treating orthopedic injuries, there has been renewed interest in the treatments for musculoskeletal disease and injury. An abundance of scientific and clinical evidence has demonstrated the relationship between the molecular healing mechanisms and the clinical success of treatment in the setting of chronic inflammation where amniotic products have been used.

While some authors aggressively point out that amniotic fluid products do not have any living stem cells, we can’t agree that it doesn’t play an important clinical role. The fact that amniotic fluid doesn’t have any living stem cells, however, shouldn’t preclude us from acknowledging its potential value in treatment, given the excellent safety record and demonstrated scientific efficacy of the product when used in the correct setting. In some patients, amniotic fluid treatment has been the ideal tool to restore their ability to enjoy their recreational and vocational pursuits almost immediately after injection and without surgery.

Amniotic Injections Potential:

Many believe the value of the amniotic product may be in it’s ability to neutralize the toxic healing environment of the degenerative joint. It has been clearly demonstrated that concentrations of tissue degrading enzymes (MMPs) that destroy cartilage and cause painful symptoms are elevated in arthritic joints.

Amniotic fluid contains regulators for healing and inflammation promoting tissue regeneration and repair.  The fluid contains growth factors which can help promote new tissue growth and also help to call in the body’s stem cells. Amniotic fluid contains important anti-inflammatory properties from biochemicals called cytokines that help relieve pain.  Amniotic fluid also contains hyaluronic acid (a prominent component of joint fluid important for lubricating cartilage and promoting growth of new cartilage).  This allows Amniotic Injections to also provide protection for joints for long term relief.

Amniotic fluid is heavily concentrated in important healing molecules, growth factors, hyaluronic acid, antimicrobial components and stem cell activators that have been proven to be effective in patients with arthritic conditions without producing an immunologic rejection response.

Dr. Jose Rivera is a Board Certified Foot & Ankle Specialist specializing in the field of regenerative foot & ankle orthopedics.  He currently practices at OrthoRegenX in Orlando, FL area and is focused on providing minimally invasive and effective regenerative treatments to provide his patients an alternative to invasive surgery.

Is PRP or Steroid injection more effective against Plantar Fasciitis?

What You’re Really Getting with an Injection of Steroids
Most patients are familiar with steroid injections, but most have no idea that PRP injections are an alternative to treat many of the same issues.

Let’s review what you’re really getting when you get a steroid injection.

Cartilage Damage
High-dose steroid injections destroy cartilage. That steroid injection into your knee, for example, might provide you with some temporary pain relief, but behind the scenes it’s wreaking havoc on your joint-cushioning cartilage. If you think you’re off the hook because your steroid injections are being injected into your foot for plantar fasciitis, think again. Your foot contains many tiny joints, all cushioned with cartilage to help provide smooth movement.

Diminishing Relief
Repeated steroid injections have been shown to provide diminishing relief with each subsequent injection. Why? Possibly because of the toxic effect steroids have on the local repairing stem cells…

Poisoned Stem Cells
Your body’s own stem cells are powerful cells that respond to damage and immediately get to work repairing it when it occurs. One study found that when mesenchymal stem cells are exposed to steroids, this, in effect, poisons the cells, stifling their ability to become bone and to repair bone. With no strong stem cells to stop it, wear and tear sets in and bone damage occurs.

Increased Risk for Bone Loss
Bone loss and osteonecrosis are well-known potential risks of steroid treatments.

Decreased Blood Supply
In order to stay healthy and effectively heal, tissues need a good blood supply. One study, however, found that when comparing patients who were undergoing rotator cuff surgery and had steroid injections prior to the surgery to those who didn’t have steroids, the steroid patients had one-third fewer blood-supply vessels.

So if you have plantar fasciitis, is there an alternative for steroid injections? Yes! Platelet rich plasma, or PRP…

What You’re Getting with an Injection of PRP
Platelet rich plasma (PRP) is concentrated from blood platelets, which are the body’s natural growth factors and healing molecules. When you have an open wound, such as a finger laceration or a skinned knee for example, it’s your platelets that rush in and start clotting your blood to stop the bleed. Your growth factors also kick in to encourage healing. It’s how the body heals itself when minor injuries occur.

To obtain PRP, blood is drawn from a vein and the whole blood is centrifuged, or rapidly spun. Centrifuging separates the plasma serum where the platelets are concentrated; hence, the result is a platelet rich plasma.

Injections of a patient’s own PRP stimulate the body’s local stem cells to wake up and start repairing damaged tissues. So PRP is like a shot of espresso for our repairman cells. PRP is used to treat many orthopedic conditions, such as muscle, ligament, and tendon tears, sprains, arthritis, and much more.

Study Favors PRP vs Steroids for Plantar Fasciitis
The purpose of the new study (http://www.footanklesurgery-journal.com/article/S1268-7731(18)30023-7/fulltext?rss=yes) was to compare the impact of PRP versus steroid injections on chronic plantar fasciitis. Both outcomes and imaging (ultrasound and MRI) were analyzed in 40 patients with plantar fasciitis—20 received PRP and 20 received steroids. Subjects were evaluated at three and six months following treatment.

The results? While there were improvements in both groups, the PRP group showed significant improvement over the steroid group. Researchers concluded that PRP injections are a “more effective therapeutic method” than steroid injections. In addition, the study goes on to say that not only is PRP safe, but that PRP treatment provides a longer-lasting solution than steroids.

The upshot? This is one of many studies that now show that PRP is better than steroids and doesn’t have the nasty side effects. If you’re a patient who is getting or about to get a steroid injection, spend a little on yourself and upgrade to a PRP shot. You’ll be glad you did!