Plantar Fasciitisc: A Comparison of Ultrasound-Guided Fasciotomy With or Without Amniotic Membrane Allograft Injection

Abstract

Aim: The purpose of this study was to evaluate the clinical response to augmenting an ultrasound-guided percutaneous plantar fasciotomy (UGPF) with an amniotic membrane (AM) allograft injection. Design: Retrospective, single-center, matched, case-controlled study. Methods: Patients underwent either an UGPF (n = 15) or a combined UGPF and AM injection (n = 16). Results: The UGPF plus AM group demonstrated a significant reduction in pain (p = 0.02) from baseline at the short-term follow-up, but there was no significant difference in pain or patient satisfaction between groups at the 52-week follow-up. Conclusion: Both groups demonstrated a significant reduction in pain and high level of patient satisfaction, but the combination of UGPF with an AM injection may provide a greater reduction in pain earlier in the post-operative period.

Plain language summary

The purpose of this study was to determine if a single injection of an amniotic membrane (AM) tissue injection improves pain and satisfaction scores for patients with chronic plantar fasciitis treated using ultrasound guided percutaneous fasciotomy (UGPF). The UGPF procedure involves using ultrasound to guide a cutting device into the plantar fascia to cut and remove degenerative tissue. 31 patients were included in the study (15 UGPF and 16 UGPF plus AM). Both groups demonstrated improvement in pain at the 16 and 52-week follow-up visits. There was a greater improvement in pain in patients treated with the UGPF and AM injection in the short term (at 16-week follow-up). There was no long-term difference between the two groups at the 52-week follow-up. Both groups demonstrated a high level of patient satisfaction. Findings suggest that combination of UGPF with AM tissue injection may improve symptoms of chronic plantar fasciitis sooner than if a patient only underwent an UGPF procedure alone. The AM allograft does not seem to change the long-term outcome. Larger studies are warranted.

Tweetable abstract

In a preliminary study, researchers found that amniotic membrane injections may provide faster pain relief when injected into the plantar fasciotomy during surgery.

Keywords::

• amniotic membrane allograft
• heel pain
• percutaneous needle tenotomy
• plantar fasciitis
• TENEX^TM

Author contributions

The authors confirm contribution to the paper as follows: study conception and design: WI Sussman; data collection: WI Sussman and T May, analysis and interpretation of results: H Nakagawa, WI Sussman, S Ashkani-Esfahani, G Waryasz; draft manuscript preparation: H Nakagawa, K Sung, WI Sussman, S Ashkani-Esfahani and G Waryasz. All authors reviewed the result and approved the final version of the manuscript.

Acknowledgments

The authors would like to acknowledge J Breeze for her assistance with statistical analysis portion of this study and H Rhee for her assistance with proofreading.

Financial & competing interests disclosure

The senior author (W Sussman) for this manuscript is an education consultant for TENEX^TM. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.

Informed consent disclosure

The authors state that they have obtained verbal and written informed consent from the patient/patients for the inclusion of their medical and treatment history within this case report.