Chronic Plantar Fasciitis: Comparison of Ultrasonic Guided Percutaneous Fasciotomy vs New Technique Combining Fasciotomy with Amniotic Membrane Allograft

Abstract

Category: Basic Sciences/Biologics Introduction/Purpose: Plantar fasciitis is a common condition affecting approximately one in ten people in their lifetime. Treatment is typically conservative and symptoms are self-limiting. Operative treatment is indicated in recalcitrant cases. Minimally-invasive partial plantar fasciotomy can be performed using ultrasound-guided percutaneous techniques and is an attractive alternative to traditional surgery. Methods: A retrospective review was performed on consecutive patients who underwent either an ultrasound-guided fasciotomy or a combined percutaneous fasciotomy with a flowable amniotic matrix allograft. All ultrasound-guided percutaneous fasciotomy procedures were performed using the Tenex TX2 cutting device. Human amniotic allograft consisted of an injection of 0.5 mL of a flowable placental tissue matrix. Outcomes were assessed at short-term (2, 8, and 16 weeks) and long-term follow-up (26 and 52 weeks). Results: Both groups demonstrated a significant reduction in pain from baseline after the respective interventions and demonstrated a high level of patient satisfaction. The only significant difference in the 2 groups was at short-term follow-up in which the percutaneous fasciotomy with the amniotic membrane allograft (n=12) showed a statistically-significant reduction (p<0.05) in pain when compared to the fasciotomy alone group (n=11). There was no difference between the 2 groups at long- term follow-up. Conclusion: Treatment of chronic plantar fasciitis using ultrasound-guided fasciotomy is an attractive alternative to traditional surgery. Ultrasound-guided fasciotomy did improve pain from baseline with high level of patient satisfaction. Furthermore, the combination of percutaneous fasciotomy with a flowable amniotic matrix allograft may provide a greater reduction in pain earlier in the post-operative period, but does not seem to alter the long-term outcome of the procedure. More subjects are needed to possibly detect long-term effects.