Advanced Regenerative Healing Options For Chronic Plantar Fasciitis
Stem Cell Therapy And Amniotic Membrane Allograft: A Glimpse Into The Future
On the forefront of tissue healing are the topics of stem cell therapy and amniotic membrane allografts. A stem cell injection, most commonly harvested from the lateral calcaneus, provides the damaged tissue with pluripotent mesenchymal cells that differentiate into the appropriate cell type for repair and regeneration.
In our practice, we have found a response to treatment at about two weeks but some patients may take up to six weeks to experience improvement in symptoms. The major downfall to this therapy is primarily the expense to the patient as insurance does not cover stem cells.
The newest of all therapy options is the use of amniotic membranes to decrease scar formation. Amniotic membrane allograft possesses anti-inflammatory properties, which does differentiate it from all of the aforementioned treatments. Nevertheless, this innovative therapy has a profound impact on decreasing scar formation and promoting growth factors to healing tissue.
Zelen and his colleagues conducted a prospective, randomized study assessing the efficacy of amniotic membrane allograft in the treatment of chronic plantar fasciitis.8 In comparison to those receiving a placebo injection of saline, those patients who received micronized dehydrated amniotic membrane allograft demonstrated significant improvement in pain and function at both one and eight weeks. By week eight, AOFAS hindfoot scores increased by a mean of 12.9 for the control group as opposed to 51.6 in the amniotic treatment group. Studies such as this are reassuring that regenerative medicine will have a place in the podiatric practice in the very near future.
We now refer to chronic, unrelenting plantar fasciitis more commonly as plantar fasciosis. This term better emphasizes the concept that recalcitrant plantar fasciitis is more of a disease consistent with a lack of inflammation and scar tissue formation. In the past, surgical plantar fasciotomy was really the only option for patients who had exhausted conservative therapy. Currently, the foot and ankle practitioner can offer a vast array of treatments before resorting to fasciotomy. Focusing attention on promoting blood flow and proliferative cells to the damaged tissue will result in the minimization of scar tissue, thinning of the plantar fascia, and overall relief of symptoms.
Dr. Baravarian is an Assistant Clinical Professor at the UCLA School of Medicine. He is the Chief of Podiatric Foot and Ankle Surgery at the Santa Monica UCLA Medical Center and Orthopedic Hospital, and is the Director of the University Foot and Ankle Institute in Los Angeles.
Dr. Ben-Ad is a Fellow at University Foot and Ankle Institute in Los Angeles.