以玻尿酸注射治療足跟脂肪墊症候群：病例報告

The Treatment of Pain with Heel Fat Pad Syndrome by Hyaluronic Acid Injection: A Case Report

張韡瀚(Wei-Han Chang) ； 吳致寬(Chih-Kuan Wu) ； 裴育晟(Yu-Cheng Pei) ； 陳芝琪(Chih-Chi Chen) ； 黃美涓(Alice MK Wong)

《台灣復健醫學雜誌》 41卷1期 (2013/03) Pp. 59-67

https://doi.org/10.6315/2013.41(1)07

摘要

足底疼痛是臨床上常見問題，足底筋膜炎是主要原因。足跟脂肪墊症候群（heel fat pad syndrome）是另一個較常見的原因，它的症狀跟足底筋膜炎類似，需要作鑑別診斷。由於足跟脂肪墊症候群造成的嚴重疼痛及失能沒有很適當的治療方式，我們嘗試將玻尿酸注射於足跟脂肪墊，治療足跟脂肪墊症候群所引起的疼痛。一位56歲男性病患主述兩腳足跟疼痛，尤其左腳更劇痛難忍。由於保守治療效果不佳，我們發現該病患足跟脂肪墊彈性不好，所以在超音波導引下將高濃度交結鏈（cross-linked）玻尿酸（Juvederm）注射於左腳足跟脂肪墊的深部真皮層。注射一個月後左足疼痛大幅改善，故右足亦接受玻尿酸注射。於注射前後及半年後，以軟組織超音波、潘氏疼痛及步行能力量表進行評估，發現病患在注射10天後，左腳增加的足跟脂肪墊厚度已經慢慢減少，但半年後疼痛指數仍由原先的第二級（走路時嚴重疼痛，使得所有日常生活活動受限制）進步到第五級（偶爾與輕微疼痛）；步行能力由第一級（只能走幾步路）進步到第三級（可短距離步行少於1 個小時），治療效果可維持半年以上。在兩年的追蹤裡，病患沒被觀察到明顯的副作用及併發症。但兩年後足部疼痛又出現，故接受第二次雙足跟玻尿酸注射，症狀得以大幅緩解。引起足跟疼痛的足跟脂肪墊特性改變有足跟脂肪墊萎縮及彈性不足等因素。本案例顯示，玻尿酸注射於足跟脂肪墊可以減輕足跟脂肪墊疼痛，並增加步行能力。可能的解釋為玻尿酸注射可以增加足跟脂肪墊厚度、增加足跟脂肪墊彈性及減低足跟壓力。高濃度交結鏈玻尿酸是否可做為足跟脂肪墊症候群所引起疼痛的治療選擇，值得進一步探討。

關鍵字

足跟脂肪墊（heel fat pad） ； 足底疼痛（plantar heel pain） ； 足底筋膜炎（plantar fasciitis） ； 玻尿酸（hyaluronic acid）

並列摘要

Plantar fasciitis and heel fat pad syndrome are two of the most common causes of plantar heel pain. Because the clinical symptoms and signs are similar, the differential diagnosis between plantar fasciitis and heel fat pad syndrome is important for proper treatment. Unfortunately, conservative treatment strategies are less effective for plantar heel pain caused by heel fat pad syndrome. We present here a 56-year-old male patient with bilateral plantar heel pain that was especially severe in the left foot. We gave him an injection of 2 ml high-concentration, cross-linked hyaluronic acid into the deep derma of the painful heel pad after conservative treatments failed. The thickness of the left heel pad increased immediately following the injection, but gradually returned to its original thickness 10 days after the injection. Evaluated at the baseline and at 6 months after the injection using ultrasonography and Pun's pain and walking scale, the patient's pain scale changed from secondary grade (severe pain when attempting to walk, preventing all activities) to fifth grade (occasional and slight pain), while the walking scale changed from first grade (bedridden or able to take only a few steps) to third grade (walking short distance, less than one hour). No significant side effects or complications were observed in the two years of follow-up. The patient received a second injection of high-concentration, cross-linked hyaluronic acid into the bilateral plantar heels again due to recurring symptoms 2 years later with good symptom remission again. The characteristic changes of the fat pad in the heel, such as fat pad atrophy and decreased elasticity, may cause plantar heel pain. The result of this case report potentially indicates that hyaluronic acid injections could be an alternative method to relieve pain and improve gait function in patients with plantar heel pain caused by fat pad changes. Increased thickness in the heel fat pad, increased elasticity, and reduced plantar pressure may account for its effectiveness. Injections of high-concentration, cross-linked hyaluronic acid into the deep derma of the plantar heel may be an effective and safe treatment for plantar heel pain.

並列關鍵字

heel fat pad ； plantar heel pain ； plantar fasciitis ； hyaluronic acid