This study is the first to use MRI analysis to measure the effectiveness of fat grafting in restoring foot pad volume and relieving pain.

Understanding Fat Pad Atrophy and Its Consequences

The natural cushioning under our feet, known as the plantar fat pad, plays a crucial role in absorbing shock and reducing pressure on our bones. However, due to aging, repeated impact, steroid use, or certain medical conditions, this protective layer thins over time, leading to direct pressure on the bones of the foot. The result? Pain, calluses, ulcers, and even changes in gait that can impact overall mobility and quality of life.

Traditional treatments such as padding and synthetic fillers provide temporary relief, but they do not restore lost volume effectively. This is where autologous fat grafting comes in as a promising, minimally invasive alternative.

The Study: A Deeper Look into Fat Grafting

Ruane et al. conducted a prospective study using MRI technology to analyze 3D volume changes in the foot before and after autologous fat grafting. Seventeen participants (six men and eleven women) suffering from fat pad atrophy underwent the procedure, receiving an average of 5.8 cc of fat injections per foot.

The key findings of the study include:

• Increased Foot Padding: MRI analysis confirmed a significant increase in metatarsal fat pad volume at six months post-operation (p=0.04).
• Pain Reduction: Participants reported lower pain scores at two and six months post-procedure (p<0.05), demonstrating lasting relief.
• Enhanced Mobility: Functional assessments revealed improvements in daily activities and sports performance (p<0.05).
• Decreased Foot Pressures and Forces: Tekscan HR Mat™ analysis showed lower plantar pressures and forces, correlating with improved comfort and mobility.

Why Fat Grafting Works So Well

While previous studies using ultrasound suggested that fat grafted under the metatarsal heads disappears within 2–6 months, MRI analysis in this study tells a different story. Instead of vanishing, the fat redistributes, providing long-term support around the metatarsal heads. This could explain why pain relief extends up to two years despite measurable reductions in direct tissue thickness.

Additionally, fat grafting offers biological benefits beyond volume restoration. The grafted fat contains stem cells, which may contribute to tissue regeneration, improving the biomechanical properties of the plantar pad. The authors are currently investigating the stem cell characteristics of the fat used in these foot fat grafting cases and aim to correlate it to clinical findings in the near future [Ruane et al, 2019].

Key Takeaways for Patients and Practitioners

For Patients:

• Long-lasting Relief: Unlike traditional padding or synthetic fillers, autologous fat grafting offers extended pain relief with a single procedure.
• Minimally Invasive: The procedure involves a simple liposuction process followed by precise fat injection.
• Improved Mobility: Reduced foot pressure and better weight distribution allow for more comfortable movement and daily activity engagement.

For Practitioners:

• MRI is a Superior Measurement Tool: Compared to ultrasound, MRI provides a more accurate assessment of fat retention and redistribution.
• Patient Selection Matters: Higher BMI correlates with lower fat retention and pain improvement.
• Potential Synergies with Other Procedures: Addressing underlying foot deformities like hammertoes alongside fat grafting may enhance outcomes.

The Future of Foot Fat Grafting

While this study provides compelling evidence of the benefits of autologous fat grafting, further research is needed to assess long-term fat retention. Exploring the regenerative potential of stem cells within grafted fat could unlock new frontiers in foot care.

As advancements in regenerative medicine continue, autologous fat grafting is poised to become a mainstream treatment for foot pain, offering a natural and effective solution for millions suffering from fat pad atrophy [Ruane et al, 2019].

Conclusion

The study by Ruane et al. reaffirms what many in the medical community have suspected—autologous fat grafting is a game-changing technique for foot pain management. With proven increases in foot pad volume, pain reduction, and functional improvement [Ruane et al, 2019]..

Have you experienced foot pain or undergone fat grafting? Learn more at:

20 Walnuts St. Suite 14

Wellesley MA 02481

(781) 591-7855

info@bsbortho.com

References:

1. Hannan MT, Menz HB, Jordan JM, et al. High heritability of hallux valgus and lesser toe deformities in adult men and women. Arthritis Care & Research 65(9):1515–21, 2013.
   
2. Ruane EJ, Minteer DM, Wyse AJ, Gusenoff BR, Gusenoff JA. Volumetric Analysis in Autologous Fat Grafting to the Foot. Plast Reconstr Surg. 2019 Sep;144(3):463e-470e.