Randomized Controlled Trial of Micronized Dehydrated Human Amnion/Chorion Membrane (dHACM) Injection Compared to Placebo for the Treatment of Plantar Fasciitis

Shawn Cazzell, Jordan Stewart, Patrick S. Agnew, John Senatore, Jodi Walters, Douglas Murdoch, Alex Reyzelman, Stuart Miller

Research output: Contribution to journalArticle


Background: Failure of conservative management to reduce/eliminate symptoms of plantar fasciitis (PF) may indicate need for advanced treatments. This study reports Level 1 evidence supporting 3-month safety and efficacy of micronized dehydrated human amnion/chorion membrane (dHACM) injection as a treatment for PF. Methods: A prospective, single-blind, randomized controlled trial was conducted at 14 sites in the United States. Subjects were randomized to receive 1 injection, in the affected area, of micronized dHACM (n=73) or 0.9% sodium chloride placebo (n=72). Safety/efficacy assessments were conducted at 4 weeks, 8 weeks, 3 months, 6 months, and 12 months postinjection, using visual analog scale (VAS) for pain, Foot Function Index–Revised (FFI-R) score, and presence/absence of adverse events. Primary outcome was mean change in VAS score between baseline and 3 months expressed as difference in means for treatment versus control subjects. Secondary outcome was mean change in FFI-R score between baseline and 3 months expressed as difference in means for treatment versus control subjects. Results: Baseline VAS scores were similar between groups. At the 3-month follow-up, mean VAS scores in the treatment group were 76% lower compared with a 45% reduction for controls (P <.0001), FFI-R scores for treatment subjects had mean reduction of 60% versus baseline, whereas control subjects had mean reduction of 40% versus baseline (P =.0004). Of 4 serious adverse events, none were related to study procedures. Conclusion: Pain reduction and functional improvement outcomes were statistically significant and clinically relevant, supporting use of micronized dHACM injection as a safe and effective treatment for PF. Level of Evidence: Level I, prospective randomized trial.

Original languageEnglish (US)
Pages (from-to)1151-1161
Number of pages11
JournalFoot and Ankle International
Issue number10
Publication statusPublished - Oct 1 2018
Externally publishedYes



  • chronic pain
  • dehydrated human amnion/chorion membrane
  • plantar fasciitis

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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