Intra-articular treatments for hindfoot osteoarthritis

Table 1 Main characteristics of orthobiologics used in hindfoot osteoarthritis treatment

Treatment	Presence of growth factors	Presence of stem cells	Source
Corticosteroids	None	None	Exogenous
Viscosupplementation	None	None	Exogenous
Platelet-rich plasma	High	None	Peripheral blood
Bone marrow aspirate	High	Minimum	Bone marrow
Adipose derived stem cells	High	High	Adipose tissue

Table 2 Stepwise treatment paradigm for hindfoot osteoarthritis

HFOA stage	Recommended clinical approach	Remarks
Early stage	Weight reduction	Prioritize conservative measures
	Physical therapy and activity modification	Injections may provide short- to midterm symptomatic relief
	Intra-articular hyaluronic acid injection (alone or with corticosteroids)
Intermediate stage	Limited repetition of corticosteroid injections during flare-ups	Careful patient selecion is key
	Orthobiologic therapies (e.g., PRP, adipose derived stem cells)	Protocols and supporting evidence are still evolving
Advanced stage	Surgical intervention (e.g., subtalar or triple arthrodesis)	Consider biomechanical implications and risk of adjacente joint overload

HFOA: Hindfoot osteoarthritis; PRP: Platelet-rich plasma.