Fat Grafting and Retention for Heel Fat Pad Atrophy
Status:
Completed
Trial end date:
2021-07-01
Target enrollment:
Participant gender:
Summary
Plantar heel pain is the most common problem of the foot. Plantar fasciitis is the leading
cause of this pain, accounting for 11-15% of all foot symptoms seeking professional care, and
occurs in 10% of the US population. The cause of heel pain can be from bone, soft tissue,
nerve, or systemic disease. The second most common cause of heel pain is fat pad atrophy,
followed by a combination of both fat pad atrophy and plantar fasciitis. [1-4] Fat pad
displacement may be seen in the heel as well.
Current treatments for plantar fasciitis include stretching and external support with
orthotics with the goal of reducing local pressure as well as tissue breakdown.[5] However,
patient compliance with extrinsic devices is challenging, and they may experience increased
friction, irritation and breakdown at a different location on the foot due to thickness of
the device in the shoe. Also, the patient must replace the device as soon as it breaks down
but the breakdown often goes unnoticed. Failure of conservative management may lead to
treatment with steroids or surgical intervention by endoscopic plantar fasciotomy, open
fasciotomy or excision of bone spurs. Injection of steroids can instigate or exacerbate
pre-existing heel fat pad atrophy. Autologous fat grafting to the heel may reduce plantar
pressures, and thus serve as a treatment for heel pain. Autologous fat grafting is currently
under investigation for a myriad of clinical scenarios.[6-19] Even though autologous fat
grafting is not yet an established therapeutic approach for the cited indications, some of
the reported results have been intriguing.[19] The variable resorption of fat, however, is an
important confounding factor in all these studies. Currently the literature reports fat
retention rates ranging from 25% to 80%.[20]
The specific aim of this study is to assess the adipose stem cell characteristics in patients
undergoing autologous fat grafting for heel fat pad atrophy and correlate these
characteristics with fat retention. Data from this study will help determine the
characteristics of the adipose stem cells in this population and open the door to additional
studies. This pilot study will also help build new collaborative efforts between Foot and
Ankle Specialists, Plastic Surgery, and Adipose Stem Cell Biologists, combining biomechanical
expertise with fat grafting and basic science expertise.
Phase:
N/A
Details
Lead Sponsor:
University of Pittsburgh
Treatments:
Anesthetics Anesthetics, Local Epinephrine Epinephryl borate Lidocaine Racepinephrine