Intra-articular treatments for hindfoot osteoarthritis

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.