Foot Pain: When Fat is Your Friend

Foot pain may seem like an unusual topic for a plastic surgery blog, but there are some exciting new techniques that are allowing plastic surgeons to make a meaningful improvement in foot pain. Specifically, foot fat grafting, or transferring fat from elsewhere in the body to the fat pads of the feet, has been shown to offer significant, long-lasting improvement in cases of foot pain connected with a loss of the foot’s natural fatty padding.

Fat grafting is a technique we have been using for years for cosmetic and reconstructive purposes. A “graft” is a piece of tissue that is moved from one part of the body to another without connecting any blood vessels (the tissue relies on blood vessels at its new location to connect to it and provide blood supply). The most commonly known example of a graft is a skin graft, frequently used in burn surgery and other reconstructive procedures. Skin is harvested from one part of the body (in a way that allows the skin to grow back) and transplanted to another part of the body where it is needed. Fat grafts follow the same principles. Fat is taken from one area of the body (but it will not grow back) and is then placed in a new location.

Fat grafting is used most frequently in aesthetic surgery. It can be harvested from areas in which you may not want fat (like your abdomen, “love handles,” or thighs) and used to add volume to areas in which it is more desirable, such as the cheeks in facial rejuvenation or the breasts in breast augmentation. One of the great things about the process is that it is very comfortable and has minimal downtime. Fat is harvested through low-volume liposuction that can be performed under local anesthesia, and it is gently introduced into target areas that have been made numb to eliminate discomfort.

It is also worth noting that while the amount of fat that will survive from a fat grafting procedure is variable (we say an average of 50%, so we will often add more than we need, or “overcorrect”), the fat that does survive does so permanently. This means that a well-planned fat grafting procedure can have a lasting, significant impact. Moreover, these long-lasting results require only an easy outpatient procedure associated with minimal discomfort and a rapid return to work (a weekend off is fairly standard).

Recently, it has been recognized that the volume provided by fat grafting could have functional as well as aesthetic purposes. Grafted fat can essentially act as a pillow. For people suffering from a loss of the fatty pads in their feet, or “plantar fat bad atrophy,” fat grafting to the feet can offer a meaningful decrease in discomfort by directly addressing the problem at hand (or foot! – sorry).

While various artificial substances have been injected into feet with the hope of addressing this lack of padding in the past, the results of these treatments has in general been fleeting at best as these products dissolve and migrate away from the site at which they are needed over time. We know from our experience that grafted fat tends to be permanent elsewhere in the body, and this longevity supports the findings in studies of foot fat grafting that show prolonged effectiveness of this technique.

Foot fat grafting may therefore offer prolonged relief to those suffering from certain causes of chronic foot pain (including even plantar fasciitis) through a simple procedure – not requiring general anesthesia – that allows for a rapid recovery and return to regular activities. This technique has even been shown to reverse severe callus formation, further contributing to its positive impact on foot health and comfort. Foot fat grafting can also be used to make walking in high heels much more comfortable. And, returning to the roots of fat grafting in aesthetic surgery, foot can be grafted to the top (or “dorsum”) of the feet to camouflage tendons and blood vessels and contribute to a rejuvenated appearance.

There are many factors that can contribute to causing and alleviating foot pain. For this reason, I work with a podiatrist that specializes in performing a thorough biomechanical assessment of each potential foot fat grafting patient’s feet. This multidisciplinary approach ensures that every treatment is designed to meet each patient’s functional needs.

Foot fat grafting (more here) is a novel procedure that may bring relief even if other attempts at treatment have failed. The procedure is office based and you can go home straight away. You can even walk right after the procedure – we just ask that you wear specialized shoe inserts for several weeks to keep pressure off the fat grafts while they are healing. So, if you have foot pain, get in touch so we can see if fat grafting may be right for you.

Author
Office of Darren M. Smith, MD

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