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Short-term efficacy and safety of hyaluronic acid injection for plantar fasciopathy

  • Ankle
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Plantar fasciopathy is the most common cause of plantar heel pain and is considered to be a type of enthesopathy. The short-term efficacy, safety, and dose-response relationship of high-molecular-weight hyaluronic acid (HA) was investigated in patients with plantar fasciopathy.

Methods

In this multicenter, prospective, randomized, double-blind, placebo-controlled trial, 168 patients with persistent pain from plantar fasciopathy for more than 12 weeks were randomly assigned to receive 2.5 mL of 1% HA (H-HA), 0.8 mL of 1% HA (L-HA), or 2.5 mL of 0.01% HA (control group) once a week for 5 weeks. The primary endpoint was improvement in visual analogue scale (VAS) score for pain from baseline to week 5.

Results

The VAS scores (least squares mean ± standard error) in each group decreased gradually after the start of treatment, a change of −3.3 ± 0.3 cm for the H-HA group, −2.6 ± 0.3 cm for the L-HA group, and −2.4 ± 0.3 cm for the control group, with the H-HA group improving significantly more than the control group (P = 0.029). No serious adverse events were reported. There was no difference between the groups in the incidence rates of adverse drug reactions.

Conclusion

The administration of five injections of high-molecular-weight HA is an effective treatment with no serious adverse drug reactions and is a conservative treatment option for plantar fasciopathy. This treatment contributed to alleviation of pain in patients with plantar fasciopathy and improvement in their activities of daily living.

Level of evidence

I.

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References

  1. Acevedo JI, Beskin JL (1998) Complications of plantar fascia rupture associated with corticosteroid injection. Foot Ankle Int 19(2):91–97

    Article  CAS  PubMed  Google Scholar 

  2. Ball EM, McKeeman HM, Patterson C, Burns J, Yau WH, Moore OA, Benson C, Foo J, Wright GD, Taggart AJ (2013) Steroid injection for inferior heel pain: a randomised controlled trial. Ann Rheum Dis 72(6):996–1002

    Article  PubMed  Google Scholar 

  3. Benjamin M, Toumi H, Ralphs JR, Bydder G, Best TM, Milz S (2006) Where tendons and ligaments meet bone: attachment sites (‘entheses’) in relation to exercise and/or mechanical load. J Anat 208(4):471–490

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Buchbinder R (2004) Clinical practice. Plantar fasciitis. N Engl J Med 350(21):2159–2166

    Article  CAS  PubMed  Google Scholar 

  5. Cole C, Seto C, Gazewood J (2005) Plantar fasciitis: evidence-based review of diagnosis and therapy. Am Fam Physician 72(11):2237–2242

    PubMed  Google Scholar 

  6. Coombes BK, Bisset L, Vicenzino B (2010) Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet 376(9754):1751–1767

    Article  CAS  PubMed  Google Scholar 

  7. Crawford F, Atkins D, Young P, Edwards J (1999) Steroid injection for heel pain: evidence of short-term effectiveness. A randomized controlled trial. Rheumatology (Oxford) 38(10):974–977

    Article  CAS  Google Scholar 

  8. Crawford F, Thomson C (2003) Interventions for treating plantar heel pain (Review). Cochrane Database Syst Rev. 3: CD000416. Review. (2010) Update. Cochrane Database Syst Rev 1:CD000416

    Google Scholar 

  9. Davies MS, Weiss GA, Saxby TS (1999) Plantar fasciitis: how successful is surgical intervention? Foot Ankle Int 20(12):803–807

    Article  CAS  PubMed  Google Scholar 

  10. Davis PF, Severud E, Baxter DE (1994) Painful heel syndrome: results of nonoperative treatment. Foot Ankle Int 15(10):531–535

    Article  CAS  PubMed  Google Scholar 

  11. de Vos RJ, Weir A, van Schie HT, Bierma-Zeinstra SM, Verhaar JA, Weinans H, Tol JL (2010) Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA 303(2):144–149

    Article  PubMed  Google Scholar 

  12. Higashiyama I, Kumai T, Hayashi K, Shinohara Y, Matsuda T, Tanaka Y, Takakura Y (2007) Effect of hyaluronic acid for plantar fasciitis. J Jpn Soc Surg Foot (Edinb) 28:25–28 (Japanese)

    Google Scholar 

  13. Jerosch J, Schunck J, Liebsch D, Filler T (2004) Indication, surgical technique and results of endoscopic fascial release in plantar fasciitis (E FRPF). Knee Surg Sports Traumatol Arthrosc 12(5):471–477

    Article  PubMed  Google Scholar 

  14. Kane D, Greaney T, Bresnihan B, Gibney R, FitzGerald O (1998) Ultrasound guided injection of recalcitrant plantar fasciitis. Ann Rheum Dis 57(6):383–384

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Kibler WB, Goldberg C, Chandler TJ (1991) Functional biomechanical deficits in running athletes with plantar fasciitis. Am J Sports Med 19(1):66–71

    Article  CAS  PubMed  Google Scholar 

  16. Kikuchi T, Shimmei M (1994) Effects of hyaluronan on proteoglycan metabolism of rabbit articular chondrocytes in culture. Jpn J Rheumatol 5:207–215

    Google Scholar 

  17. Kumai T, Benjamin M (2002) Heel spur formation and the subcalcaneal enthesis of the plantar fascia. J Rheumatol 29(9):1957–1964

    PubMed  Google Scholar 

  18. Kumai T, Muneta T, Tsuchiya A, Shiraishi M, Ishizaki Y, Sugimoto K, Samoto N, Isomoto S, Tanaka Y, Takakura Y (2014) The short-term effect after a single injection of high-molecular-weight hyaluronic acid in patients with enthesopathies (lateral epicondylitis, patellar tendinopathy, insertional Achilles tendinopathy, and plantar fasciitis): a preliminary study. J Orthop Sci 19(4):603–611

    Article  CAS  PubMed  Google Scholar 

  19. Leach RE, DiIorio E, Harney RA (1983) Pathologic hindfoot conditions in the athlete. Clin Orthop Relat Res 177:116–121

    Google Scholar 

  20. Lutter LD (1986) Surgical decisions in athletes’ subcalcaneal pain. Am J Sports Med 14(6):481–485

    Article  CAS  PubMed  Google Scholar 

  21. Martinelli N, Marinozzi A, Carnì S, Trovato U, Bianchi A, Denaro V (2013) Platelet-rich plasma injections for chronic plantar fasciitis. Int Orthop 37(5):839–842

    Article  PubMed  Google Scholar 

  22. Mishra A, Woodall J Jr, Vieira A (2009) Treatment of tendon and muscle using platelet-rich plasma. Clin Sports Med 28(1):113–125

    Article  PubMed  Google Scholar 

  23. Moretti B, Garofalo R, Patella V, Sisti GL, Corrado M, Mouhsine E (2006) Extracorporeal shock wave therapy in runners with a symptomatic heel spur. Knee Surg Sports Traumatol Arthrosc 14(10):1029–1032

    Article  PubMed  Google Scholar 

  24. Muneta T, Koga H, Ju YJ, Mochizuki T, Sekiya I (2012) Hyaluronan injection therapy for athletic patients with patellar tendinopathy. J Orthop Sci 17(4):425–431

    Article  CAS  PubMed  Google Scholar 

  25. Neufeld SK, Cerrato R (2008) Plantar fasciitis: evaluation and treatment. J Am Acad Orthop Surg 16(6):338–346

    Article  PubMed  Google Scholar 

  26. Neustadt D, Caldwell J, Bell M, Wade J, Gimbel J (2005) Clinical effects of intraarticular injection of high molecular weight hyaluronan (Orthovisc) in osteoarthritis of the knee: a randomized, controlled, multicenter trial. J Rheumatol 32(10):1928–1936

    CAS  PubMed  Google Scholar 

  27. Park YB, Choi WA, Kim YK, Lee SC, Lee JH (2012) Accuracy of blind versus ultrasound-guided suprapatellar bursal injection. J Clin Ultrasound 40(1):20–25

    Article  Google Scholar 

  28. Petrella RJ, Cogliano A, Decaria J, Mohamed N, Lee R (2010) Management of tennis elbow with sodium hyaluronate periarticular injections. Sports Med Arthrosc Rehabil Ther Technol 2:4

    PubMed  PubMed Central  Google Scholar 

  29. Ragab EM, Othman AM (2012) Platelets rich plasma for treatment of chronic plantar fasciitis. Arch Orthop Trauma Surg 132(8):1065–1070

    Article  PubMed  Google Scholar 

  30. Rathleff MS, Mølgaard CM, Fredberg U, Kaalund S, Andersen KB, Jensen TT, Aaskov S, Olesen JL (2015) High-load strength training improves outcome in patients with plantar fasciitis: a randomized controlled trial with 12-month follow-up. Scand J Med Sci Sports 25(3):e292–e300

    Article  CAS  PubMed  Google Scholar 

  31. Rathleff MS, Thorborg K (2015) ‘Load me up, Scotty’: mechanotherapy for plantar fasciopathy (formerly known as plantar fasciitis). Br J Sports Med 49(10):638–639

    Article  CAS  PubMed  Google Scholar 

  32. Riddle DL, Pulisic M, Pidcoe P, Johnson RE (2003) Risk factors for plantar fasciitis: a matched case-control study. J Bone Jt Surg Am 85-A(5):872–877

    Article  Google Scholar 

  33. Riddle DL, Schappert SM (2004) Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors. Foot Ankle Int 25(5):303–310

    Article  PubMed  Google Scholar 

  34. Saito S, Furuya T, Kotake S (2010) Therapeutic effects of hyaluronate injections in patients with chronic painful shoulder: a meta-analysis of randomized controlled trials. Arthritis Care Res (Hoboken) 62(7):1009–1018

    Article  CAS  Google Scholar 

  35. Schepsis AA, Leach RE, Gorzyca J (1991) Plantar fasciitis. Etiology, treatment, surgical results, and review of the literature. Clin Orthop Relat Res 266:185–196

    Google Scholar 

  36. Speed C (2014) A systematic review of shockwave therapies in soft tissue conditions: focusing on the evidence. Br J Sports Med 48(21):1538–1542

    Article  PubMed  Google Scholar 

  37. Tamoto K, Nochi H, Tokumitsu Y (1994) High molecular weight hyaluronic acids inhibit interleukin-1-induced prostaglandin E2 generation and prostaglandin E2-elicited cyclic AMP accumulation in human rheumatoid arthritis synovial cells. Jpn J Rheumatol 5:227–236

    Google Scholar 

  38. Tang T, Muneta T, Sekiya I (2008) Fibrous change of the infrapatellar fat pad due to strenuous running exercise and its treatment with intraarticular hyaluronan injection in a rat model. J Med Dent Sci 55(1):163–173

    PubMed  Google Scholar 

  39. Weiss C, Levy HJ, Denlinger J, Suros JM, Weiss HE (1986) The role of Na-hylan in reducing postsurgical tendon adhesions. Bull Hosp Jt Dis Orthop Inst 46(1):9–15

    CAS  PubMed  Google Scholar 

  40. van der Worp H, van den Akker-Scheek I, van Schie H, Zwerver J (2013) ESWT for tendinopathy: technology and clinical implications. Knee Surg Sports Traumatol Arthrosc 21(6):1451–1458

    Article  PubMed  Google Scholar 

  41. Zhang W, Robertson J, Jones AC, Dieppe PA, Doherty M (2008) The placebo effect and its determinants in osteoarthritis: meta-analysis of randomised controlled trials. Ann Rheum Dis 67(12):1716–1723

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank the study investigators, their staff, and their patients for participating in this clinical study. The following investigators participated in the study: Jun Tsujino, Keijinkai Teine Keijinkai Hospital; Satoru Nakajo, Nakajo Orthopaedic Clinic; Atsushi Kita, Japanese Red Cross Sendai Hospital; Masahito Hatori, Tohoku University School of Medicine; Kazuo Ohuchi, Fukushima Medical University; Satoru Ozeki, Koshigaya Hospital, Dokkyo University School of Medicine; Akihiro Tsuchiya, Funabashi Orthopaedic Sports Medicine Center; Masato Takao, Teikyo University School of Medicine; Michiyasu Kayaoka, Tokyo Rosai Hospital; Yasunori Tsukimura, Kitasato Institute Hospital; Hisateru Niki, St. Marianna University School of Medicine; Atsushi Kato, Ando Orthopaedics Hospital; Ikuo Wada, Nagoya City University Hospital; Tatsuya Koike, Osaka City University Graduate School of Medicine; Hiroshi Nakajima, Otemae Hospital; Mitsuo Kinoshita, Osaka Medical College; Yoshitaka Ishizaki, Higashiosaka City General Hospital; Ichiro Higashiyama, Matsukura Hospital; Masatoshi Naito, Fukuoka University Faculty of Medicine; Toshio Inoue, Hakujyuji Hospital; Hiroshi Tsurukami, Tsurukami Orthopaedic Clinic; Shunji Oba, Oba Orthopaedics. This study was funded by Chugai Pharmaceutical Co., Ltd. (Chugai). Investigational drugs were provided at no cost by Chugai. Publication of this article was not contingent upon approval by Chugai.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan

    Tsukasa Kumai, Norihiro Samoto, Kazuya Sugimoto, Yasuhito Tanaka & Yoshinori Takakura

  2. Agatsuma Higashi Orthopaedic Clinic, 756-1, Isemachi, Nakanojo-machi Agatsuma-gun, Gumma, 377-0423, Japan

    Atsushi Hasegawa

  3. Ishii Orthopaedic and Rehabilitation Clinic, 1089-1, Shimo-Oshi, Gyoda-shi, Saitama, 361-0037, Japan

    Hideo Noguchi

  4. Shiranita Orthopaedic Clinic, 1-6-13, Shiragane, Kokurakita-ku Kitakyushu-shi, Fukuoka, 802-0074, Japan

    Atsushi Shiranita

  5. Shiraishi Orthopaedic Pain Clinic, 5-41-16, Nakakasai, Edogawa-ku, Tokyo, 134-0083, Japan

    Masaharu Shiraishi

  6. Department of Orthopaedic Surgery, Ken-Ai Memorial Hospital, 1191, Kimori, Onga-cho, Onga-gun, Fukuoka, 811-4313, Japan

    Satoshi Ikeda

Authors
  1. Tsukasa Kumai
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  2. Norihiro Samoto
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  10. Yoshinori Takakura
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Corresponding author

Correspondence to Tsukasa Kumai.

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Conflict of interest

Yoshinori Takakura has received consulting fees from Chugai. Tsukasa Kumai, Norihiro Samoto, Atsushi Hasegawa, Hideo Noguchi, Atsushi Shiranita, Masaharu Shiraishi, Satoshi Ikeda, and Kazuya Sugimoto received grants from Chugai as study investigators. Yasuhito Tanaka declares no conflict of interest.

Funding

This study was funded by Chugai Pharmaceutical Co., Ltd. (Chugai). Investigational drugs were provided at no cost by Chugai. Publication of this article was not contingent upon approval by Chugai.

Ethical approval

The study was performed in accordance with the ethics principles of the Declaration of Helsinki and was conducted with the approval of the institutional review boards at each of the centers where the study was performed.

Informed consent

Informed consent was obtained from all individual participants included in this study.

Appendix

Appendix

This study was conducted at the following institutions after receiving IRB approval: Teine Keijinkai Hospital (ID: TKH2010-06), Nakajo Orthopaedic Clinic (ID: NJ-20100324), Japanese Red Cross Sendai Hospital (ID: SD-20100420), Tohoku University School of Medicine (ID: 101004), Fukushima Medical University (ID: TI22002), Higashimaebashi Orthopaedic Clinic (ID: HM-20100319), Koshigaya Hospital, Dokkyo University School of Medicine (ID: 10-01), Ishii Orthopaedic and Rehabilitation Clinic (ID: IS-20100319), Funabashi Orthopaedic Sports Medicine Center (ID: FS-20100318), Teikyo University School of Medicine (ID: TK-20100401), Tokyo Rosai Hospital (ID: RS-20100721), Kitasato Institute Hospital (ID: KK-20100617), Shiraishi Orthopaedic Pain Clinic (ID: SS-20100311), St. Marianna University School of Medicine (ID: A2036-Unv.), Ando Orthopaedics Hospital (ID: AD-20100709), Nagoya City University Hospital (ID: 11-10-0006), Osaka City University Graduate School of Medicine (ID: OC-20100625), Otemae Hospital (ID: OT-20100319), Osaka Medical College (ID: 10-1-08-0260), Higashiosaka City General Hospital (ID: TS-20100326), Matsukura Hospital (ID: MK-20100421), Nara Prefecture General Medical Center (ID: NK-20100318), Nara Medical University (ID: 10-002), Kyushu Rosai Hospital (ID: KR-20100511), Fukuoka University Faculty of Medicine (ID: 10-003), Hakujyuji Hospital (ID: HJ-20100309), Ken-Ai Memorial Hospital (ID: KA-20100330), Tsurukami Orthopaedic Clinic (ID: TR-20100401), and Oba Orthopaedics (ID: OB-20100610).

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Kumai, T., Samoto, N., Hasegawa, A. et al. Short-term efficacy and safety of hyaluronic acid injection for plantar fasciopathy. Knee Surg Sports Traumatol Arthrosc 26, 903–911 (2018). https://doi.org/10.1007/s00167-017-4467-0

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  • DOI: https://doi.org/10.1007/s00167-017-4467-0

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