Patients who suffer from pedal fat pad atrophy, or the loss of fat in the ball of the foot, may benefit from an innovative new procedure that involves restoring the lost padding by grafting fat from other areas of the body, according to a first-of-its-kind clinical trial by experts at the University of Pittsburgh Department of Plastic Surgery. The results are available today online in the journal Plastic and Reconstructive Surgery.
"The fat pads in the foot act as a shock absorber when we walk, cushioning the structures around them. People with pedal fat atrophy face tremendous pain with each step they take," said lead author Jeffrey Gusenoff, M.D., associate professor of plastic surgery, University of Pittsburgh School of Medicine. "The loss of this important natural padding of fat, which can be triggered by age, obesity, high-heeled shoes or abnormal foot mechanics, among other causes, gives the sensation of walking on bone, making even standing for a short period nearly impossible."
Dr. Gusenoff led a multidisciplinary team that included podiatry and plastic surgery clinicians as they examined 25 patients divided into two groups. One group was treated immediately with fat grafting, with follow-up after one year. The minimally invasive procedure allowed them to leave the office on their feet with the help of padded sneakers. Strenuous activity was restricted for four to six weeks, and no barefoot walking was permitted during that time. A second group was treated with conservative management of symptoms for a year.
The study found that, after one year, patients in the first group demonstrated improved foot function and reduced pain with no change in tissue thickness or foot pressure. The conservatively managed group experienced a decrease in tissue thickness with an increase in foot pressure. Ultimately, fat injections to the foot may prevent worsening of the condition compared to going without treatment, the study found, and continuing analysis will determine long-term effects.
"Our team brought together different areas of medical expertise, allowing us to study pedal fat pad atrophy and fat grafting from a unique perspective," said Dr. Gusenoff. "Combining plastic surgery and podiatry gave us the strong understanding that was necessary to find a solution that improves quality of life for our patients."
Additional authors on the study were Beth Gusenoff, D.P.M., Ryan Mitchell, M.D., Kwonho Jeong, M.S., and Dane Wukich, M.D., all of Pitt. This clinical trial was supported by The Plastic Surgery Foundation and the Pitt Department of Plastic Surgery, and the treatment is currently available at UPMC.
Article: Autologous Fat Grafting for Pedal Fat Pad Atrophy: A Prospective Randomized Clinical Trial, Gusenoff, Beth R. D.P.M. et al., Plastic and Reconstructive Surgery, doi: 10.1097/PRS.0000000000002667, published November 2016.