Fat Transfer for Plantar Heel Pain: A Case Series

G Lafford, S Nour, S Wharton

Background: Plantar heel pain (PHP) affects 4-7% of the population [1]. It encompasses a range of different pathologies [2]. Heel fat pad atrophy is thought to be the second leading cause of PHP [3]. Atrophy of the heel fat pad leads to decreased cushioning over the calcaneus. The associated pain can be disabling and lead to reduced mobility and social isolation. This case series describes how fat transfer can alleviate symptoms of PHP.

Methods: Twenty-one procedures of fat transfer were performed using the Coleman technique [4] for PHP between 2013 and 2023. All surgical candidates had clinical and/or radiological evidence of heel fat pad atrophy and suffered from intractable PHP. Other pathologies, including plantar fasciitis, were excluded prior to surgery. All surgical candidates undertook the Manchester-Oxford Foot Questionnaire (MOXFQ) Patient Reported Outcome Measure prior
to surgery and at 3 months postoperatively.

Results: The mean preoperative MOXFQ Index score was 71.3 (SD 8.1). The mean postoperative MOXFQ score was 35.9 (SD 15.7). The reduction in mean MOXFQ Index score was 35.9. Paired t-testing revealed a statistically significant reduction in the MOXFQ index score (p < 0.0001). There were no cases of reoperation. There were no recorded postoperative complications.

Conclusions: This case series study highlights the potential efficacy of autologous surgical fat transfer in alleviating intractable PHP associated with heel fat pad atrophy. This case series is limited by its small sample size and long study window. Despite initial and promising results, further research evaluating a larger cohort is warranted.