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Fat Grafting for Fat Pad Atrophy of the Heel: Early Findings from a Randomized Controlled Clinical Trial
James IB, Gusenoff BR, Wang S, DiBernardo G, Minteer DM, Gusenoff JA
University of Pittsburgh
2017-02-15
Presenter: Isaac James
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.
Director Name: Nguyen, Vu
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background:
The specialized fat pad of the heel protects the foot from harsh repetitive stress generated during the gait cycle. Heel fat pad atrophy causes pain with ambulation and can cause substantial disability. Current management is limited to offloading orthotics and padding. The present study describes use of autologous fat grafting to treat heel fat pad atrophy.
Methods:
5 patients (3 female, 2 male) underwent fat grafting to the macrochamber of the heel. Fat graft processed and injected by Coleman technique was introduced into the macrochamber compartment of 6 heels (average volume of 6.5cc per heel). Ultrasound-measured tissue thickness, pedobarograph-measured foot forces, and Manchester Foot Pain and Disability Index (MFPDI) were obtained at preoperative, 1mo, and 2mo visits. Patients were offloaded in a customized Darco shoe for 4wks post-operatively.
Results:
Average age was 59.8yrs. Average BMI was 25.8. No patients had diabetes or were active smokers. The macrochamber was significantly thicker both at rest and under load at 1 and 2mo postoperatively (p≤0.05). This translated to significantly reduced heel force and pressure during the gait cycle at 1mo post-op (p≤0.05) and trended toward reduced pressure and force at 2mo (p=0.08). Patient-reported outcome measures trended toward reduced pain and improved function with several patients resuming previously untolerated activities. 6mo follow-up is pending, but results with the first two patients are consistent with 1 and 2mo findings.
Conclusions:
Restoring the plantar fat pad with autologous fat grafting can improve foot function, enhance shock absorption, and return patients to activities of daily living.
