Hyaluronic Acid Injection – Foot & Ankle

What is hyaluronic acid?

Hyaluronic acid is a substance naturally found within the body and is an important component of synovial fluid – the fluid contained within healthy joints.

Synovial fluid helps joints move smoothly and provides lubrication and shock absorption.

With osteoarthritis and degenerative joint changes, the properties of the synovial fluid can change.

Hyaluronic acid injections are designed to supplement the joint's naturally occurring hyaluronic acid and improve the viscoelastic and lubricating properties of the joint fluid.

Which hyaluronic acid products do we use?

There are several different medical hyaluronic acid preparations available.

At The Podiatry Clinic, products may include:

• Ostenil® / Ostenil® Plus
• Durolane®
• Sinovial® / Sinovial HL®

These products differ in their formulation, concentration and molecular characteristics.

Your podiatrist will select an appropriate product according to the joint being treated, your diagnosis and your individual circumstances.

Why has a hyaluronic acid injection been recommended?

Hyaluronic acid may be considered where joint pain, stiffness or restricted movement is affecting walking, exercise or everyday activity.

It may be particularly considered for osteoarthritis and degenerative joint pain.

Depending on your diagnosis, this may include selected:

• ankle joint osteoarthritis
• big-toe joint osteoarthritis / hallux rigidus
• other painful or degenerative foot and ankle joints; and
• selected joint conditions where your podiatrist considers hyaluronic acid appropriate.

It can be particularly useful to consider when a patient wishes to explore a non-steroid injection option as part of conservative management.

Not every painful joint is suitable for a hyaluronic acid injection.

Your podiatrist will have considered your diagnosis, examination findings, medical history, previous treatment and the joint being treated before recommending it.

How does hyaluronic acid work?

Hyaluronic acid acts within the joint fluid and may help improve its lubricating and shock-absorbing properties.

The treatment may help to:

• improve joint lubrication
• reduce friction within the joint
• improve the viscoelastic properties of synovial fluid
• reduce pain and stiffness
• improve joint movement; and
• make walking, exercise and rehabilitation more comfortable.

Hyaluronic acid may also have biological effects within the joint that influence inflammation and pain.

The purpose of the injection is primarily to improve symptoms and function.

It should not be considered a treatment that can reliably reverse established osteoarthritis or regrow damaged cartilage.

Why do we use ultrasound guidance?

At The Podiatry Clinic, ultrasound guidance is normally used for foot and ankle joint injections.

Many joints within the foot and ankle are relatively small and surrounded by important tendons, nerves and blood vessels.

Ultrasound allows your podiatrist to visualise the joint and surrounding structures beneath the skin and guide the needle towards the intended treatment area.

Depending on the condition, ultrasound may also help assess the joint and surrounding soft tissues before treatment.

What happens during the procedure?

Before proceeding, your podiatrist will confirm the joint being treated, review relevant medical information and discuss the procedure with you.

You will have an opportunity to ask questions before providing consent.

The skin is cleaned using an appropriate antiseptic solution.

Ultrasound is normally used to identify the joint and guide the procedure.

A sterile needle is then carefully introduced into the joint and the hyaluronic acid is administered.

A small dressing may be applied afterwards.

The injection itself normally takes only a short time, although your appointment allows time for assessment, preparation and appropriate aftercare advice.

What does the injection feel like?

You will feel the needle entering the skin and may experience pressure, stinging or temporary discomfort as the injection is administered.

Some joints can feel temporarily full or pressurised as the hyaluronic acid enters the joint.

Most patients tolerate the procedure well.

Your podiatrist will explain what to expect according to the particular joint being treated.

What results can I expect?

Hyaluronic acid injections are widely used in the conservative management of osteoarthritis and degenerative joint pain.

The aim of treatment is to provide a meaningful reduction in pain and stiffness and improvement in joint function, helping you walk and perform everyday activities more comfortably.

Response varies between patients.

Some people experience a significant and sustained improvement, while others experience a smaller improvement or little benefit.

The response can depend on:

• the joint being treated
• the severity of the osteoarthritis or joint damage
• how long symptoms have been present
• your activity levels
• other factors affecting the joint; and
• your individual response to treatment.

Scientific evidence for hyaluronic acid is stronger for some joints than others, and research specifically involving foot and ankle joints remains more limited and variable.

Your podiatrist will therefore recommend treatment according to your individual diagnosis and clinical findings, rather than assuming that every arthritic joint will respond in the same way.

Improvement cannot be guaranteed.

When should I expect improvement?

Hyaluronic acid does not necessarily provide immediate pain relief.

Some patients begin to notice improvement over the following days or weeks, while for others the response develops more gradually.

Unlike a local anaesthetic injection, the aim is not simply to numb the joint temporarily.

Where treatment is successful, improvement may continue for several months, although the duration varies considerably between individuals.

What happens after the injection?

You will normally be able to walk following your appointment.

We generally recommend taking things relatively easy for the remainder of the day and avoiding unnecessary strenuous or high-impact activity immediately after the injection.

You may temporarily experience:

• mild discomfort
• aching
• a feeling of pressure or fullness within the joint
• mild swelling
• tenderness; or
• minor bruising around the injection site.

These effects normally settle.

Your podiatrist will advise you about returning to exercise and higher-impact activities according to the joint and condition being treated.

Hyaluronic acid works best as part of a treatment plan

An injection may help improve pain and movement, but it does not necessarily address all the factors contributing to your joint problem.

Depending on your diagnosis, your treatment plan may also include:

• activity modification
• strengthening and mobility exercises
• footwear advice
• joint protection strategies
• taping or bracing
• orthotics
• gait or pressure analysis
• weight management where relevant; and
• other treatments where appropriate.

Reducing pain may provide an opportunity to move more comfortably and participate more effectively in rehabilitation and everyday activity.

What are the potential benefits?

Potential benefits of hyaluronic acid injection include:

• targeted treatment directly into the affected joint
• a non-steroid injection option
• potential reduction in joint pain
• potential reduction in stiffness
• potential improvement in joint movement and function
• improved comfort when walking and exercising
• relatively short procedure
• little downtime for most patients
• ability to combine treatment with rehabilitation; and
• an additional non-surgical option for managing painful osteoarthritis or degenerative joint disease.

What are the possible side effects and risks?

Hyaluronic acid injections are generally well tolerated.

Common temporary effects can include:

• discomfort during the injection
• soreness afterwards
• mild swelling
• temporary stiffness or fullness within the joint; and
• bruising around the injection site.

Less common risks include:

• a more significant inflammatory reaction within the joint
• bleeding or more significant bruising
• infection
• irritation of nearby structures
• nerve irritation or injury
• blood-vessel injury; and
• allergic or hypersensitivity reaction to the injected product.

Serious complications are uncommon when patients are appropriately assessed and the procedure is performed using suitable clinical precautions.

Is hyaluronic acid suitable for everyone?

Hyaluronic acid injection is not appropriate for every patient or every joint condition.

Your podiatrist will consider factors including:

• your diagnosis
• the joint being treated
• active infection or recent illness
• infection or skin problems around the injection site
• allergies or previous reactions to injectable products
• significant swelling or joint effusion
• inflammatory joint disease
• anticoagulant or antiplatelet medication
• pregnancy or breastfeeding
• previous injections or surgery; and
• other medical conditions that may affect treatment.

Some precautions also vary according to the specific hyaluronic acid product being considered.

Your podiatrist will select the product only after considering whether it is appropriate for you.

Please tell us about any significant change in your health or medication before your injection.

Can hyaluronic acid injections be repeated?

If you experience a useful improvement and symptoms later return, another injection may sometimes be considered.

The decision will depend on:

• how well you responded previously
• how long the improvement lasted
• the joint being treated
• progression of the underlying condition; and
• what other treatment options are available.

Repeat treatment is not automatically required and will be considered according to your individual circumstances.

What are the alternatives?

Your alternatives depend on your diagnosis.

These may include:

• activity modification
• rehabilitation and exercise
• footwear changes
• taping or bracing
• orthotics
• pain-relieving medication
• corticosteroid injection where appropriate
• other injection treatments where clinically appropriate
• Class IV laser or shockwave for appropriate associated conditions
• further imaging
• specialist orthopaedic assessment
• surgery for selected advanced joint conditions; or
• choosing not to have the injection and continuing with conservative management.

Your podiatrist can explain which alternatives are relevant to your particular condition.

How much does a Hyaluronic Acid Injection cost?

Hyaluronic Acid Injection – Foot & Ankle: £350

The appropriate hyaluronic acid product will be selected according to your condition and the joint being treated.

The fee includes the injection procedure and ultrasound guidance where clinically appropriate.

When should I contact the clinic?

Some temporary soreness, aching or fullness following an injection can be normal.

Please contact the clinic if you develop:

• pain that becomes severe or continues to increase
• significant or increasing swelling
• increasing redness or warmth
• discharge from the injection site
• persistent numbness or weakness
• a significant unexpected change in function; or
• anything else that concerns you following treatment.

Seek urgent medical advice

Joint infection following an injection is uncommon but requires prompt assessment.

Seek urgent medical advice if you develop severe or increasing joint pain associated with marked swelling, redness or heat, particularly if you also feel unwell or develop a fever.

Seek emergency medical assistance if you develop symptoms of a serious allergic reaction, such as difficulty breathing or significant swelling of the face, lips, tongue or throat.

Your next step

If you have already booked your injection

Please attend your appointment as arranged.

Make sure we are aware of your current medication, allergies and any significant changes in your medical history.

If you have developed an infection, started antibiotics, become pregnant or there has been another important change in your health, please tell us before treatment.

Your podiatrist will review the procedure with you and answer any questions before you provide consent.

If a hyaluronic acid injection has been recommended but you have not yet booked

You can book your Hyaluronic Acid Injection – Foot & Ankle appointment when you are ready to proceed.

£350

Important information

This information sheet supports the discussion you have had with your podiatrist and is intended to help you make an informed decision about treatment. It does not replace individual clinical advice.

Hyaluronic acid provides a non-steroid injection option for the management of selected painful and degenerative joint conditions. The aim is to reduce symptoms and improve function while helping you remain active and participate in your wider treatment or rehabilitation programme.

Individual responses vary and improvement cannot be guaranteed.

Before treatment, your podiatrist will confirm that the injection and selected product remain appropriate, discuss the relevant benefits, risks and alternatives with you, and provide an opportunity to ask questions before giving your consent.

The Podiatry Clinic