The visual analog scale (VAS) is an instrument used to quantify the level of pain reported by patients. The VAS ranges from 0 to 10 with 0 representative of no pain, 1–3 indicating mild pain, 4–6 indicating moderate pain, and 7– 10 representative of severe pain. Preoperative pain was selfreported as severe in all patients, with amean of 8.2 (Table 1).
Changes in self-reported pain were monitored every 2 weeks for 12 weeks after procedure. Changes in pain over time were
statistically determined using the Freidman nonparametric repeated measures ANOVA with Dunn’s post hoc test for multiple comparisons.
For patients experiencing plantar fasciosis there was a significant improvement in pain scores in all patients by postoperative week four (𝑝 < 0.05, Figure 1), with a mean pain score of 5.2 (Table 1) indicative of moderate pain. By postoperative week 10 the pain scores weremarkedly reduced (𝑝 < 0.0001, Figure 1) and the average self-reported scores indicated that the majority of patients experienced only mild pain.
Similar results were observed in patients experiencing Achilles tendinosis, and all patients gave self-reported pain scores not higher than moderate pain by postoperative week 6, with an average pain score of 4.7 (Table 1) ranging from 1 to 6 (Figure 2). By 12 weeks after treatment the average pain
score had reduced to only 2.3 (Table 1) indicating that the majority of patients were experiencing mild pain. Therefore, after treatment with granulized amniotic membrane and amniotic fluid pain was significantly reduced compared to preoperative pain, with the majority of patients reporting only mild pain.
7. Discussion and Conclusion
Heel pain is a common problem that may be present in 15% of patients presenting to their primary care physician [26].
In this study we show for the first time to our knowledge that a single injection of hAM-AF allograft is sufficient to significantly reduce heel pain caused by plantar fasciosis and Achilles tendinosis. At the end of the study all patients showed a significant improvement in pain, and on average
self-reportedpainhadreduced fromsevere tomild.Our findings suggest that amniotic allografts create the appropriate environment needed to promote tissue repair and healing in complex soft-tissue disorders such as plantar fasciosis and
Achilles tendinosis.
Plantar fasciosis is the most common cause of inferior heel pain and is often due to repetitive mechanical stress, producing microtears and inflammation of the fascia and perifascial soft tissues. The condition is commonly seen in individuals who are susceptible to injury such as runners and
obese patients [27]. To date there is no definitive treatment proven to be the best option for plantar fasciosis. Treatment is patient dependent and commonly requires a combination of different therapies to successfully alleviate symptoms [28].
Inmany cases patients do not respond to current treatments and symptoms persist.This is likely due to the fact that plantar fasciosis is not simply the product of mechanical stress and is actually the result of a number of contributing factors associated with aberrant tissue development and healing. Factors include enthesopathy in associationwith seronegative spondyloarthropathies, such as ankylosing spondylitis, Reiter syndrome, or psoriatic arthritis [29]. Findings from MRI studies have shown a number of other tissue abnormalities associated with plantar fasciosis, including plantar fascial thickening and intrafascial edema [29].
Achilles tendinosis is also a common cause of heel painin a sport-active population and is responsible for reduced physical performance and increased severe pain over several years [30].