Volumetric Analysis in Autologous Fat Grafting to the Foot

Abstract

Background: Pedal fat grafting is a safe, minimally invasive approach to treat pedal fat pad atrophy. Prior randomized controlled trials demonstrate that the fat as measured directly under the metatarsal heads disappears between 2 and 6 months after fat grafting, despite patients having relief for 2 years. The authors aim to use magnetic resonance imaging to further assess three-dimensional volume of fat in the foot after autologous fat grafting to help explain the mechanism for improved pain. Methods: A prospective study was performed using magnetic resonance imaging before and at 6 months after pedal fat grafting to assess changes in the three-dimensional morphology of the fat. Results: Seventeen patients (six men and 11 women) underwent injections with a mean volume of 5.8 cc per foot. At 6 months, patients demonstrated increased tissue thickness (p = 0.008) and volume (p = 0.04). Improvements were seen in pain (p < 0.05) and activity (p < 0.05). Foot pressures and forces were significantly decreased and positively correlated with increased fat pad volume (p < 0.05). Conclusions: Pedal fat grafting significantly increases metatarsal fat pad volume. The distribution of the fat may contribute to lasting clinical relief in these patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Patient Selection for Pedal Soft Tissue Augmentation

“…The technique for fat injection utilized the Coleman method and is described in our previous reports on foot fat grafting. 2 , 3 There were no differences between the intervention and control groups in our previous studies.…”

“… 2 , 5 The thickness of the fat pad is initially increased and then returns to baseline with long-term increases in the volume of the fat pad distributed around the metatarsal head. 3 Other benefits of pedal autologous fat grafting to various areas of the foot have been shown, including improvement of skin quality, treating adult flatfoot deformity, and decreasing the frequency of diabetic foot wounds. 7-9 …”

“…Increased fat is seen redistributed around the metatarsal head with no increased tissue thickness of the fat pad under the metatarsal head of the forefoot. 3 …”

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.…”

Role of autologous fat transplantation combined with negative-pressure wound therapy in the treatment of diabetic wounds in a rat model

“…4 Autologous fat transplantation (AFT) has become a widely used technique in reconstructive plastic surgery. 5 It has the advantages of available tissue sources and low immunogenicity. However, transplanted adipose tissue cannot tolerate hypoxia, easily liquefies, has a low survival rate, and has difficulty reconstructing the blood circulation.…”