Learn more about foot pad grafting as a treatment option.

If you have chronic foot pain, you’ve probably tried a variety of treatments and medications. If those approaches have provided little to no improvement, you may be losing hope.

“Please don’t give up,” advises Jeffrey Gusenoff, MD, a plastic surgeon at UPMC. He and his wife, podiatrist Beth Gusenoff, DPM, a researcher at the University of Pittsburgh, are offering a new treatment that’s showing remarkable success in treating certain types of foot pain. It’s called foot fat grafting.

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The Pain of Atrophy

You may not think of the foot as a fatty part of the body, but the ball and heel have specialized fat pads that act like the body’s shock absorbers. Fat pad atrophy occurs when these pads deteriorate, usually through repetitive use or injury.

“Nearly one in three adults over age 60 has this problem,” explains Dr. Jeffrey Gusenoff. “Athletes, people who stand for long periods each day, and those who’ve had fractures, surgery, or repeated steroid injections also are likely to have fat pad atrophy.”

Dr. Beth Gusenoff notes that the atrophy can be caused by other issues, including systemic diseases such as rheumatoid arthritis and diabetes. People who have high arches or habitually wear high heels, those with jobs that require standing for a long time, or those who over-train athletically may lose foot pad fat. The two doctors also are developing a novel treatment for people with chronic plantar fasciitis through the use of the person’s own fat.

“There’s a great deal of pressure when the fat is gone, so you’re in a lot of pain,” says Dr. Jeffrey Gusenoff. “It can be debilitating. We’ve seen people on crutches, people who tell us they’re basically crawling around the house because they can’t put pressure on their feet.”

When people lose mobility, they often get depressed and become housebound, adds Dr. Beth Gusenoff. “We see retired people who can’t entertain, can’t play with their grandchildren, can’t take trips. They are suffering, and their function is gone.”

Collaborating on a Solution

The two doctors came up with the idea for foot pad grafting together. “We were talking during dinner one night, and it struck us: We do a lot with fat injections elsewhere — why can’t we put them in the foot?” explains Dr. Jeffrey Gusenoff.

They began a two-year clinical trial in 2013 at the University of Pittsburgh Department of Plastic Surgery. The results, published in the December 2018 issue of Plastic and Reconstructive Surgery, showed that people experienced pain relief and improved quality of life for up to two years after the fat injections. In fact, they improved more with foot fat grafting than with traditional treatments like orthotic insoles or steroid injections.

“We’ve had people come in from as far away as Australia and California to have the procedure done,” says Dr.  Beth Gusenoff. “This procedure has provided relief from foot pad atrophy to many people.”

How Foot Fat Grafting Works

Foot fat grafting is a minimally invasive procedure that doesn’t require a hospital stay. “We perform the procedure in the office using local anesthesia,” says Dr. Jeffrey Gusenoff. A small portion of fat is removed from a fatty area like the belly or thighs using liposuction. The fat is then cleaned in a centrifuge and injected into the foot.

“Because it’s your own fat, the body doesn’t reject it,” explains Dr. Jeffrey Gusenoff. “Foot fat grafting is a simple, quick procedure. We bandage the foot, then modify the patient’s shoe and/or insole to reduce pressure on the grafted area. Typically, patients can walk out of the office.” The doctors and staff are in regular communication with patients throughout the six- to eight-week recovery period.

The procedure is best for people who don’t smoke, don’t have an active infection, and don’t have uncontrolled diabetes.

Foot fat grafting is currently available through Regenerative Cell and Tissue Therapies at UPMC, a specialized center in the UPMC Department of Plastic Surgery. To make an appointment or for more information, call 412-641-3960.