Chronic foot pain due to fat transfer is a notorious issue seen in patients with fat pad atrophy, and a revolutionary treatment is about to hit the world stage.
Fat Pad Atrophy is actually a struggle
Fran Borovitz loved walking for long distances with friends, but it became harder and harder to do because of severe discomfort. “The ball of my foot felt like bone — there was hardly any padding left,” she recalls. Cushioned shoes, padded inserts, nothing alleviated the pain. Then she saw a brochure about treatment for fat pad atrophy and immediately recognized the symptoms. “I thought, ‘This is me! Maybe there’s hope,’” she says.
Who Is at Higher Risk?
Fat pad atrophy is especially common in people with high arches, those who are obese or those who’ve had steroid injections in their feet.
“Fat pad atrophy happens when people lose the natural padding in the ball or heel of the foot. Over time, this constant pressure on these areas breaks down their shock absorbers so pain and inflammation sets in,” said Dr. Beth Gusenoff, a podiatrist at the University of Pittsburgh Medical Center (UPMC).
To address this, Drs. Jeff and Beth Gusenoff — husband-and-wife plastic surgeon and podiatrist — have investigated how to best perform fat graft treatments to help reduce the pain caused by foot fat loss by replacing the lost cushioning.
Not everyone is eligible for Fat Grafting Foot Pain Treatment
Eligible candidates for fat pad atrophy treatment include individuals who:
- Suffer ongoing pain under the forefoot despite the use of padding and cushioned footwear
- Are non-smokers
- Do not have diabetes
- Do not have conditions that are inflammatory
“We do liposuction all the time for other parts of the body — such as the face and breasts — so there’s no reason we can’t do that to restore cushioning in the foot,” says Dr. Jeffrey Gusenoff, a plastic surgeon at UPMC.
The old treatments used silicone injections, but they have fallen out of favor. “Replating like with like is the best approach,” he adds.
Fat Grafting Foot Pain Technique
Before the Procedure:
Foot pressure analysis and ultrasound imaging are used to measure fat pad thickness in patients.
Day of the Procedure:
- Through liposuction, some fat is removed from the belly, hips, or flank.
- The fat is then harvested, purified, and injected into the foot under local anesthesia.
- Patients can walk right after the procedure.
- Patients should avoid high-impact activities for the first 4 – 6 weeks.
Potential Side Effects
Fat pad atrophy treatment, like any medical procedure, does have some risks. These may include:
- Bruising around both the injection and liposuction sites
- Transient swelling or tenderness
But patients in their study have not needed narcotic pain medications or antibiotics after the procedure, Dr. Gusenoff notes. Recovery and pain are measured over the following months.
Improving Quality of Life
“Our patients are not looking for stilettos. The patients may just want to walk around a grocery store or with their children comfortably,” Dr. Beth Gusenoff says of her patients.
In their study of 30 patients, half received instant-fat injections and half waited a year, padded. Those receiving fat grafting foot pain treatment showed significantly improved quality of life, less pain and an increased ability to tolerate foot pressure.
Future Steps
Researchers plan next to conduct larger multi-center trials, potentially adding MRI evaluations.
“It’s immensely gratifying to help patients with pain and loss of function recover mobility. We’ve had people come in on crutches, and then come back and go back to normal activities — even competitive dancing,” says Dr. Beth Gusenoff.
“I am very pleased with my results,” raved Fran, who had fat pad atrophy treatment two years ago. “I can walk my dog again, I can keep up with friends — it’s working!” she says.
Such promising technology for treating foot pain through fat grafting promises to alleviate thousands and return them to an active lifestyle.
