Ultrasound-Guided Injection of High Molecular Weight Hyaluronic Acid versus Corticosteroid in Management of Plantar Fasciitis: A 24-Week Randomized Clinical Trial

Figures & data

Figure 1 Ultrasound-Guided Injection Practice.

Figure 2 The Consolidated Standards of Reporting Trials (CONSORT) diagram of the current study.

Table 1 Baseline Characteristics of the Participants in the Groups

Variable	HA^a	CS^b	P-value
n	38	37	-
Age (year)	41.73 ± 7.68	40.33 ± 10.17	0.510
Gender (female:male)	18:20	22:15	0.293
Weight (kg)	77.00 ± 7.70	79.81 ± 6.41	0.096
Body mass index (kg/m^2)	27.01 ± 1.96	27.70 ± 1.43	0.092
Job
Difficult employees	4	5	0.057
Not difficult employees	19	16
Housewife	10	16
Unemployed	5	0
SID (right:left)	25:13	21:16	0.208
Duration of symptoms (months)	7.30 ± 3.50	6.92 ± 3.63	0.650

Notes: ^aHyaluronic Acid Injection Group. ^bCorticosteroid Injection Group

Table 2 Within Group Analysis of Outcomes Over the Time

	VAS^a	FAAM^b	PPT^c	USV^d	FFI^e
HA^f
Baseline	8.00 ± 1.35	46.65 ± 9.82	48.83 ± 7.84	49.57 ± 7.04	78.92 ± 14.34
6 weeks	3.05 ± 2.33	65.27 ± 11.93	57.51 ± 12.29	45.95 ± 5.92	33.73 ± 20.08
24 weeks	3.24 ± 2.24	70.32 ± 14.96	61.74 ± 12.97	44.52 ± 5.90	28.97 ± 22.85
*P-value	<0.001	<0.001	<0.001	<0.001	<0.001
CS^g
Baseline	7.77 ± 1.06	45.36 ± 6.39	46.71 ± 5.24	48.42 ± 4.85	74.46 ± 7.32
6 weeks	2.40 ± 2.16	70.11 ± 12.97	65.77 ± 11.52	42.66 ± 4.66	29.71 ± 15.89
24 weeks	3.49 ± 1.93	67.29 ± 14.17	63.14 ± 14.52	43.76 ± 5.31	31.93 ± 20.17
*P-value	<0.001	<0.001	<0.001	<0.001	<0.001

Notes: *P-values refer to changes over time within each treatment group, based on the Repeated Measures. P-values of <0.05 were considered significant. ^aVisual Analog Scale. ^bFoot and Ankle Ability Measure. ^cPressure Pain Threshold. ^dUltrasonography Thickness Values. ^eFunctional Foot Index. ^fHyaluronic Acid Injection Group. ^gCorticosteroid Injection Group.

Table 3 Between Group Analysis of Outcomes Over the Time

Time	HA^a	CS^b	P-value
Baseline
VAS^c	8.00 ± 1.35	7.72 ± 1.04	0.430
FAAM^d	46.65 ± 9.82	45.36 ± 6.39	0.508
PPT^e	48.83 ± 7.84	46.71 ± 5.24	0.281
USV^f	49.57 ± 7.04	48.42 ± 4.85	0.465
FFI^g	78.92 ± 14.34	74.46 ± 7.32	0.104
6 Weeks
VAS	3.05 ± 2.33	2.40 ± 2.16	0.222
FAAM	65.27± 11.93	70.11 ± 12.97	0.103
PPT	57.51 ± 12.29	65.77 ± 11.52	0.004*
USV	45.95 ± 5.92	42.66 ± 4.66	0.011*
FFI	33.73 ± 20.08	29.71 ± 15.89	0.352
24 Weeks
VAS	3.24 ± 2.24	3.49 ± 1.93	0.625
FAAM	70.32± 14.96	67.29 ± 14.17	0.380
PPT	61.74 ± 12.97	63.14 ± 14.52	0.696
USV	44.52 ± 5.90	43.76 ± 5.31	0.604
FFI	28.97 ± 22.85	31.93 ± 20.17	0.597
Satisfaction	(3,2,7,15,10)^h	(3,3,12,11,7)	0.618

Notes: *P-values of <0.05 were considered significant. ^aHyaluronic Acid Injection Group. ^bCorticosteroid Injection Group. ^cVisual Analog Scale (mm). ^dFoot and Ankle Ability Measure. ^ePressure Pain Threshold. ^fUltrasonography Thickness Values. ^gFunctional Foot Index. ^hCount: 1: Very Dissatisfied, 2: Dissatisfied, 3: Neutral, 4: Satisfied, 5: Very Satisfied.

Table 4 Comparing the Success Rate Between Groups Over the Time

Time	HA^a	CS^b	P-value
Success Rate ≥ 30%
VAS^c	29	25	0.304
FAAM^d	24	22	0.564
PPT^e	16	18	0.289
USV^f	0	0	-
FFI^g	27	23	0.322
Success Rate ≥ 50%
VAS	21	20	0.570
FAAM	24	22	0.395
PPT	8	11	0.232
USV	0	0	-
FFI	23	19	0.326

Notes: ^aHyaluronic Acid Injection Group. ^bCorticosteroid Injection Group. ^cVisual Analog Scale. ^dFoot and Ankle Ability Measure. ^ePressure Pain Threshold. ^fUltrasonography Thickness Values. ^gFunctional Foot Index.

Figure 3 The visual analog scale (VAS) trend of changes in the hyaluronic acid (HA) and corticosteroid injection (CS) groups.

Figure 4 The pressure pain threshold (PPT) trend of changes in the hyaluronic acid (HA) and corticosteroid injection (CS) groups.

Figure 5 The ultrasonographic ultrasonography thickness values (USV) trend of changes in plantar fascia in the hyaluronic acid (HA) and corticosteroid injection (CS) groups.

Figure 6 The functional foot index (FFI) trend of changes in the hyaluronic acid (HA) and corticosteroid injection (CS) groups.

Figure 7 The foot and ankle ability measure (FFAM) trend of changes in the hyaluronic acid (HA) and corticosteroid injection (CS) groups.