Taking on Chronic Heel Pain- a Fresh Option

When that Achilles Tendonitis or Plantar Fasciitis just will not resolve  

Tendon injury is extremely common and can occur with trauma, overuse and aging. Symptoms typically include pain, inflammation and dysfunction. Tendon healing can be very slow, and normal healing can take up to ten weeks. Most people will have relief with conservative measures, including orthotics, anti-inflammatory medication, cortisone injections, and physical therapy. But there are cases where tendons fail to regain full function with conservative management. Even with surgery, tendons may heal with fibrosis and scar tissue, leading to less strength and a higher rate of re-injury. These chronic tendon injuries may show tendon cell depletion, collagen breakdown and a high potential for failed healing. Though it may seem that inflammation is present (which is required for normal healing), the mediators that help progression of the healing process are absent. In these situations the body’s inflammatory response stops and there may be no further healing.  


Amniotic membrane and stem cell allograft  

Amniotic membrane allograft comes from the innermost layer of the amniotic sac, which surrounds the fetus. The amniotic membrane is harvested from a consenting donor during scheduled cesarean section.  This collection poses no ethical concerns because it is normally discarded after birth and there is no harm or danger to the fetus or mother when it’s extracted. After it is gathered, the amniotic fluid is sent to an FDA approved lab where it is processed and the fluid is cryogenically frozen and stored. Amniotic fluid and stem cells are not immunologically reactive, so there is no reaction between unrelated donors and recipients. Amniotic membrane synthesizes cytokines and growth factors (chemicals needed for proper healing), and amniotic stem cells can develop into different types of tissue. This ability of cells to differentiate into new tendon cells can generate new tendon tissue, while tendon repair may be stimulated by the production of growth factors and cytokines.


What to expect when your doctor uses this regenerative medicine  

In the office setting, amniotic membrane allograft can be injected into the injured tendon or plantar fascia.  There may be some discomfort associated with the injection, but most practitioners will mix it with a local anesthetic to help limit pain.  It is important that no non-steroidal anti-inflammatory medications be taken for a month before this injection and for a few months following. A period of rest of up to a month for the tendon or plantar fascia is necessary after the injection is given. Many times a positive response to the injection will mean surgery can be avoided. But amniotic stem cell use can be a planned part of a surgery, leading to better long-term healing. Amniotic membrane and stem cell use is a safe option to discuss with your podiatrist if your plantar fasciitis or tendonitis has not resolved with other conservative management.                 


Foot and Ankle Surgeon Dr. Erika SchwartzDr. Erika Schwartz works in two offices for your convenience– Washington, DC (K Street) and Chevy Chase, MD.

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