Prospective, randomized, blinded, comparative study of injectable micronized dehydrated amniotic/chorionic membrane allograft for plantar fasciitis--a feasibility study.
BACKGROUND
Specialized treatment of plantar fasciitis that can reduce inflammation and promote healing may be a possible alternative prior to surgical intervention. We report the results of a randomized clinical trial examining the efficacy of micronized dehydrated human amniotic/chorionic membrane (mDHACM) injection as a treatment for chronic refractory plantar fasciitis.


METHODS
An institutional review board-approved, prospective, randomized, single-center clinical trial was performed. Forty-five patients were randomized to receive injection of 2 cc 0.5% Marcaine plain, then either 1.25 cc saline (controls), 0.5 cc mDHACM, or 1.25 cc mDHACM. Follow-up visits occurred over 8 weeks to measure function, pain, and functional health and well-being.


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.


CONCLUSIONS
In patients with refractory plantar fasciitis, mDHACM is a viable treatment option. Larger studies are needed to confirm our findings.


METHODS
Level I, prospective randomized study.
Professional Education and Research Institute, Inc, Roanoke, VA, USA.
Charles M
CM
Zelen
Attila
A
Poka
James
J
Andrews
D064591:Allografts; D000779:Anesthetics, Local / Q000008:administration & dosage; D001684:Biological Dressings; D002045:Bupivacaine / Q000008:administration & dosage; D002908:Chronic Disease; D036981:Fasciitis, Plantar / Q000601:surgery*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D012717:Sesquiterpenes; D059039:Standard of Care; D016896:Treatment Outcome
D000779:Anesthetics, Local; D012717:Sesquiterpenes; C017538:microlenin; D002045:Bupivacaine
allografts; amniotic membrane; heel pain; micronized dehydrated human amniotic chorionic membrane; plantar fasciitis