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Treatment in atrophy of the fat pad

Discussion in 'General Issues and Discussion Forum' started by linnievh, Apr 15, 2014.

  1. linnievh

    linnievh Member


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    Good Afternoon,

    I've got a question about treatments is atrophy of the fat pad.
    I have a lot of patients who are suffering with fatpad atrophy in the heel and forefoot.
    Mostly, I will make soft inlays to create some damping.
    I'm curious about other treatments than inlays and gel pads.
    Who have any experiences with other treatments?

    greetz Linda
     
  2. superironman

    superironman Welcome New Poster

    I've found some success with using a deeper heel seat to help control the calcaneal fat pad. Taping sometimes can give some immediate and temporary relief. I'll usually try those two approaches while I work on any mobility or motor control issues.
     
  3. Blaise Dubois

    Blaise Dubois Active Member

     
    Last edited by a moderator: Sep 22, 2016
  4. Admin2

    Admin2 Administrator Staff Member

  5. CamWhite

    CamWhite Active Member

    Telic sandals and Joya shoes can be helpful for fat pad atrophy. the soft, resilient material cushions the calcaneus and met heads very nicely.
     
  6. Dennis Kiper

    Dennis Kiper Well-Known Member

    Dr Martin Krinsky, (in the 80's) conceptualized the use of a silicone filled orthotic to replace or supplement the pathological state of the fat pad.
     
  7. UKA Pod

    UKA Pod Active Member

    Can silicone filler injections work?
     
  8. Craig Payne

    Craig Payne Moderator

    Articles:
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    You have 4 options long term:
    1. Stop the activity that hurts it
    2. Progressively adapt the tissues to the load
    3. Replace the missing tissue --> inject it
    4. "Replace the missing tissue" --> soft tissue supplements (eg poron, silcone, etc)
     
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    The relationship of heel fat pad thickness with age and physiques in Japanese
    Toshihiro Maemichi et al
    Clin Bio: July 25, 2020
     
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    Filler in the foot: treatment of plantar fat pad atrophy with dermal fillers
    Amy Miller
    Journal of Aesthetic NursingVol. 10, No. Sup1C: 17 Feb 2021
     
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    News Release 25-Jan-2022
    Fat injections could treat common cause of foot pain
    PITTSBURGH, Jan. 25, 2021 – A novel technique that transplants a patient’s own fat into the sole of their foot could offer relief to those suffering from a common and painful condition called plantar fasciitis, according to University of Pittsburgh School of Medicine researchers.

    In a pilot study, published today in Plastic and Reconstructive Surgery and led by a wife-and-husband team, the fat injection procedure improved symptoms of plantar fasciitis in patients, laying the groundwork for a larger clinical trial.

    “We developed this procedure to harness the regenerative properties of fat,” said Jeffrey Gusenoff, M.D., professor of plastic surgery at Pitt. “In this proof-of-concept study, we showed that fat injections into the foot reduced heel pain, helped patients get back to doing sports and activities and boosted quality of life.”

    Plantar fasciitis, or PF, is one of the most common causes of heel pain, affecting about 2 million people in the United States. It’s caused by inflammation of the plantar fascia, connective tissue that runs from the heel to the toes and supports the foot arch.

    "Plantar fasciitis is exceptionally painful,” said Beth Gusenoff, D.P.M., clinical assistant professor of plastic surgery at Pitt. “When you get up from a sitting position or from sleeping, it’s a sharp, searing pain that some people describe as being like a nail going right through their heel.”

    The acute form of PF can be treated with stretching, shoe orthotics or cortisone injections. But about 10% of patients progress to the chronic form in which the foot’s collagen degenerates and the plantar fascia thickens. For these patients, surgical release of the plantar fascia with a small cut can help, but this surgery comes with risks, according to Beth Gusenoff.

    “Recently, there has been a plea among podiatrists to stop cutting the plantar fascia because some people get a lot of scar tissue, which causes pain,” she explained. “And if too much is cut, the foot can become destabilized, so people end up with almost like a floppy foot.”

    Inspired by the regenerative properties of fat stem cells, the Gusenoffs developed a technique that uses fat harvested from a patient’s belly or other body area.

    “In fat, there are stem cells and growth factors that help bring in fresh blood supply, which drives a mode of wound healing with reduced scarring,” explained Jeffrey Gusenoff. “We use a blunt needle to perforate the plantar fascia, which makes a small injury to stimulate the healing process. Then, when we pull the needle back, we inject a little bit of the patient’s fat.”

    To test this method, the team recruited 14 patients with chronic PF and split them into two groups. Group 1 participants received the procedure at the beginning of the study and were followed for 12 months, and their Group 2 counterparts received the procedure after a six-month observation period and were followed for an additional six months.

    “We found that Group 1 had improvements in quality of life and sports activity, decreased plantar fascia thickness and reduced pain levels,” said Jeffrey Gusenoff. “And a lot of the measures that were improving six months after the procedure got even better by 12 months.”

    Similarly, Group 2 showed decreased plantar fascia thickness and increased sports activity six months after the procedure, and there was a slight, but not statistically significant, improvement in pain levels. With a larger sample size and a longer follow-up time, the researchers said it’s likely they would have seen stronger improvements in this group.

    According to the Gusenoffs, this study provides proof-of-concept that fat injections can treat PF, and they now are planning a larger clinical trial to validate these findings. With enough evidence, they hope that the procedure will be deemed a medical necessity so that it can be covered by insurance and become more widely available in the future.

    In previous work, the Gusenoffs showed that fat injections can help solve another type of foot pain caused by loss of the fat pads that cushion the ball of the foot and heel.
     
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    Perforating Fat Injections for Chronic Plantar Fasciitis: A Randomized, Crossover Clinical Trial
    Gusenoff, Beth R. D.P.M.; Minteer, Danielle Ph.D.; Gusenoff, Jeffrey A. M.D.
    Plastic and Reconstructive Surgery: February 2022 - Volume 149 - Issue 2 - p 297e-302e
     
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    This clinical trial was just registered:
    STEP Trial for Heel Fat Pad Syndrome (STEP)
     
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