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Despite being associated with mechanical stress, recent studies have shown that this pathology also affects an older population with less involvement in sporting activities,
suggesting that tissue degeneration, in some cases ageassociated, contributes to its pathogenesis. Recent reports also highlight the heterogeneity of Achilles tendinopathy
pathogenesis and have identified multiple synergistic risk factors including genes, age, circulating and local cytokine production, sex, biomechanics, and body composition
[31].
Current conventional treatments for heel pain include physical therapy, rest, stretch exercise, nonsteroidal antiinflammatory
drugs (NSAIDs), and steroid injections.
Steroid injection is one of the most popular options [32]; however, it may produce serious side effects such as a recognized risk of subsequent plantar fascia rupture [33].
Consequently, treatments that only address the symptoms of plantar fasciosis and Achilles tendinosis are often unsuccessful, and treatments able to stimulate wound
healing are highly sought.
Provision of factors that provide a regenerative stimulus is an emerging treatment strategy which aims at alleviating
chronic tendinopathies characterized by a poor healing ability. Recent studies have shown that provision of platelet rich plasma (PRP)—rich in platelet derived growth factors—can provide a local regenerative stimulus for tissue healing.
Achilles tendinopathy patients receiving PRP injections showed significant improvements after treatment; however,
these improvements took several months to occur [34]. MSCs are an emerging alternative option to promote tissue regeneration. Recently, several studies in animal models have shown that administration of hMSCs can improve healing in tendon injuries. Specifically, hMSCs can support tendon
healing through better vascularization, larger deposits, and better organization of the extracellular matrix [35]. Although
overall this treatment procedure may be clinically safe, cartilage and bone formation at the implantation site is an expected adverse event [35]. In addition procurement of hMSCs is associated with invasive surgical procedures and ethical concerns.
Amniotic tissue allografts are also associated with softtissue repair and regeneration. Specifically, recent studies
have shown that amniotic allografts contain angiogenic growth factors that promote amplification of angiogenic cues by inducing endothelial cell proliferation and migration to promote the formation of blood vessels in vivo [36]. Such grafts offer promising stem cell therapies with the potential topromote revascularizationand tissue healingwithinpoorly vascularized, nonhealing wounds. In addition, amniotic allografts are not associatedwith problematic procumbent procedures
and contain additional factors with anti-inflammatory and anti-microbal properties. However, preservation of these properties during processing remains a challenge.
To date, the efficacy of amniotic tissue allografts in rescuing chronic heel pain has not been demonstrated. In the present study, cryopreserved (PalinGen SportFLOW) hAMAF was injected into the tissues of patients who experienced severe heel pain and who were unresponsive to existing
therapies. Significant improvements in pain were observed 4 weeks after treatment in all patients, with almost complete pain recovery in many patients by the end of the study. Our observations suggest that cryopreserved hAM-AF mediates the biological properties required for effective and rapid tissue healing and repair. Our findings support the use of PalinGen SportFLOW allograft as a promising therapy for plantar fasciosis and Achilles tendinosis and other soft-tissue disorders associated with deficiencies in the normal wound
healing processes.