Abdominal fat transfer for recreating fat pad in hind foot and forefoot

A. Malhotra, E. Dickenson, S. Wharton, A. Marsh

Introduction: Primary functions of heel and forefoot fat pad - shock absorber at heel strike, energy dissipation, load bearing, grip and insulation. Reliability of weight bearing heel pad thickness measurements by ultrasound has been determined by Rome et al. Importance of soft tissue fillers has been recently popularised by Coleman.

Methods: Harvesting done by standard low pressure liposuction using small cannula. Grafting using small needle depositing the small globules of fat in multiple layers of soft tissue. There is an expectation that up to 50% of the fat will be lost and so upto 19mls of fat placed per foot. Patients were kept NWB for 4-6 weeks post op and then allowed to mobilise fully. Case notes were prospectively collated and analysed. Pre and post-op ultrasound scans were performed to document the depth of the heel/forefoot fat pad. Clinical pictures were taken and post-op patient satisfaction scores were done as well.

Results: We treated 9 feet in 5 patients. 5 heel fat pad transfers and 4 forefoot. Pain completely relieved in all feet. No complications. Average pre-op VAS - 3/ Post-op - 9. Average pre-op AOFAS score - 70/ post-op - 105. Follow-up 6months - maximum 23 months.

Conclusion: Fat transfer is usually used for cosmetic reasons and occasionally to improve scars. Very few reports from South America have been published for patients using high heels giving pain but none for patients with a pathological anomaly. The technique seems to highly effective with no complications so far. It is currently being used on other painful problems in other areas of the sole with equal success. Abdominal fat transfer is an innovative technique aimed at getting rid of the 'heel pad syndrome'.