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Perforating Fat Injections for Plantar Fasciosis: A Regenerative Solution?

Wendy Chen,Beth Gusenoff, Sanja Sljivic, Gabriella DiBernardo, Danielle Minteer, Jeffrey A Gusenoff
University of Pittsburgh
2018-02-02

Presenter: Wendy Chen, MD, MS

Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The resident worked with an attending with an existing database to analyze and interpret data, prepare for submission.

Director Name: Vu T Nguyen

Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction

Intro: Chronic plantar fasciitis (PF) involves foot plantar fascia degeneration, leading to pain and decreased quality of life. Current treatment options can be invasive, with complication risks, or non-invasive, with inconsistent results. We propose a novel method of perforating fat injections to regenerate the plantar fascia and reduce pain.

Methods: This is a prospective randomized controlled pilot study. Included patients had chronic PF with thickening (>4mm), failed standard treatment, >6mos from any surgical intervention, and complied with follow-up. Patient with diabetes, wounds, cancer, coagulopathy, or tobacco use were excluded.
Patients were randomized to observation or intervention groups. Intervention involved perforating fat injections to the PF at multiple sites. Patients were evaluated at baseline, 1-/2-/6-months. Data included validated foot pain and function questionnaires, ultrasound, and physical exam. Unpaired t-test was used (p<0.05).
Results: Most patients were middle-aged women (control, n=8; intervention, n=10) and had plantar fasciitis >4 years. Average injection volume was 1.6cc/foot. At baseline, no significant difference in PF thickness, functionality, disability, and pain between the groups. Two months after intervention, experimental group had improved ankle/hindfoot scores (p=0.039), reporting good satisfaction; and improved activities of daily living (p=0.039). At 6mos (n=5), the intervention group had improved pain scores (p=0.021). No complications were observed. Net increase in PF thickness of 15.8% was observed.
Conclusion: This pilot study demonstrates promising improvements in pain, activity, and satisfaction with a novel, minimally invasive fat grafting procedure. The fat may have a regenerative potential to help remodel the chronically thickened plantar fascia and eliminate pain.

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