Ultrasound-guided hyaluronic acid injection for the treatment of insertional Achilles tendinopathy: A prospective case series

Abstract

BackgroundHeel pain is a common condition and often involves the Achilles tendon and is classified as insertional or non-insertional. Several operative and non-operative treatments have been described, but there is no consensus on the most effective therapy. The aim of this study is to evaluate a case series of patients with insertional Achilles tendinopathy refractory to conservative treatment submitted to a single-dose ultrasound-guided injection of hyaluronic acid (40 mg/2.0 mL). MethodsWe prospectively included 25 patients (29 feet) who underwent a single ultrasound-guided injection of hyaluronic acid after conservative treatment failure. Clinical outcomes such as pain (using the Visual Analog Scale – VAS), function (using the American Orthopedic Foot & Ankle Society – AOFAS score), personal satisfaction, and complications were evaluated. Statistical analysis was performed using the R software. ResultsMost patients were female (80%) and there was a right-side predominance (55%). The median VAS was 8 points [range 4–10] at baseline, decreasing to 3 points [range 0–8] at the six-month follow-up, with statistical significance (p < .001). The median AOFAS score was 71 points [range 38–87] at baseline, increasing to 90 points [range 48–100] at the six-month follow-up (p < .001). The personal satisfaction level was 69%, and 48% of patients considered the result excellent. There were no Achilles tendon ruptures, infections, or allergic reactions post injection. ConclusionSingle-dose injection of hyaluronic acid is a safe treatment option, improving function and reducing pain for six months in patients with insertional Achilles tendinopathy after conservative treatment failure. Level of evidenceIV, case series.