Patient Selection for Pedal Soft Tissue Augmentation

Abstract

Background Pedal fat grafting has been shown to improve pain and functional impairment from forefoot fat pad atrophy. Objectives We aimed to determine if patient demographics and foot characteristics play a role in the level of impact that is achieved following surgery. Methods We performed a retrospective review of patients who received forefoot autologous fat injections for the treatment of pedal fat pad atrophy. Patient improvement of pain and functional impairment were evaluated for correlation with patient characteristics including gender, age, BMI, unilateral versus bilateral injections, flexible versus rigid arch, previous foot deformity or surgery, and presence of callus. Results Forty-four patients received fat injections into the ball of their foot. 73% of them were women; their mean age was 61 years and mean BMI was 26.6 kg/m2. 75% had injections performed bilaterally; 41% had a flexible arch, 73% had a past history of pedal deformity or surgery, and 43% had callus. Only female gender was found to correlate with an improvement in pain from the time of surgery to 12 months later (p=0.02). Conclusions Bilateral rigid, high arched foot type is a risk factor for foot pain and disproportionately represented among these patients. The only patient characteristic found to be correlated with improvement in pain at 12 months post-surgery was female gender. BMI and laterality of injections impacted the course of improvement after surgery. Given current data, all patients with suspected pedal fat pad atrophy should be considered for soft tissue augmentation.

Remission Strategies with Fat Grafting to Prevent Recurrence of Pedal Ulcerations and Pain: A Case Series

“…14 PFG has been successfully implemented as treatment for a number of pedal conditions such as diabetic foot ulcers, pedal fat pad atrophy, thromboangiitis obliterans, plantar fibromatosis, and plantar osteochondromas. 4,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] Although it has be shown that grafted lipoaspirate redistributes over time in the plantar foot surface, it retains its supportive and analgesic function. 22 Considering this, the investigators expected that PFG holds potential therapeutic benefit to treat conditions, which results in elevated localized pedal pressure by providing a mechanism to dissipate said elevated pressure.…”

A New Minimally Invasive Procedure for Treating Plantar Heel Pain

“…However, external devices are prone to breakdown, and are inconvenient and cause patient compliance issues. In recent years, studies have demonstrated that pedal fat grafting significantly increases metatarsal fat pad volume and is beneficial for the treatment of pedal fat pad atrophy 8,9 . However, there is only 1 report of a pilot study of fat transplantation to treat chronic heel pain in adults after surgery for flat foot deformity 10 .…”

“…In recent years, studies have demonstrated that pedal fat grafting significantly increases metatarsal fat pad volume and is beneficial for the treatment of pedal fat pad atrophy. 8,9 However, there is only 1 report of a pilot study of fat transplantation to treat chronic heel pain in adults after surgery for flat foot deformity. 10 In addition, traditional fat transplantation has a high absorption rate.…”