[Translated article] Exploratory study of the efficacy and safety of treatment with high-low molecular weight hybrid hyaluronic acid in patients with plantar fasciitis: One-year follow-up.

内容摘要

Plantar fasciitis (PF) is a common musculoskeletal injury that can occur in adults of all ages and activity levels. This condition accounts for more than 1 million medical visits annually in the United States alone. Despite its name, PF is considered a degenerative condition rather than a primary inflammatory disorder. It is characterized by pain in the medial part of the heel that worsens with weight-bearing activity and prolonged standing. Treatment for PF can be conservative, including stretching complemented by formal physical therapy, NSAIDs, and orthotics. If symptoms have not improved after these options, the use of injectable treatments should be considered. If symptoms persist for more than 6 months, surgical release could be considered as a last resort. Different studies have demonstrated the efficacy and safety of high molecular weight hyaluronic acid (HA) injections in the treatment of patients with PF. The objective of the study was to evaluate the efficacy and safety of treatment with hybrid high-low molecular weight hyaluronic acid (HA) in patients diagnosed with plantar fasciitis through retrospective analysis of medical records. Patient functionality was assessed using the Spanish-validated Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ), and pain level was measured with the Verbal Numeric Rating Scale (VNRS), both before the procedure and after 12 months of post-treatment follow-up, in 10 patients diagnosed with PF who were administered hybrid high-low molecular weight HA (Sinovial HL&#xae; 1&#x2009;ml) through ultrasound-guided injection into the plantar fascia. In all cases, the thickness of the plantar fascia was evaluated by ultrasound before the procedure and at 12 months. A significant reduction in pain assessed by the VNRS was observed when comparing baseline data to values at 12 months post-procedure (P<.001). In all cases, patients reported total absence of pain 12 months after the HA injection. Likewise, a statistically significant reduction in MOXFQ scores was observed between baseline values and those obtained at the 12-month follow-up. The mean scores decreased from 57.2&#x2009;&#xb1;&#x2009;4.3 points at baseline to 2.5&#x2009;&#xb1;&#x2009;2.8 points at 12 months, with a median difference of -55 points (IQR: -58.2 to -50.8; P=.002). Regarding the evaluation of ultrasound changes in plantar fascia thickness, the analysis revealed a statistically significant reduction at 12 months after the procedure compared to baseline measurements (median difference: -2.25&#x2009;mm, IQR: -2.85 to -1.95; P=.002). The body mass index (BMI) was 27.8%, and the predominant gender was male (70%) compared to female (30%). The baseline characteristics of the patients and the results of the tests performed are shown in table 1. Ultrasound-guided infiltration with hyaluronic acid hybrid high-low molecular weight into the plantar fascia in patients with plantar fasciitis or intrafascial fiber rupture is an effective and safe treatment that maintains its positive effects for at least one year after the procedure. The use of ultrasound plays a fundamental role both at the time of infiltration and in the follow-up of the condition.