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Long-Term Outcomes of Autologous Fat Grafting for Pedal Fat Pad Atrophy
Chinemeh Eyiba, BS, MS; Alexander J. Comerci, BS; Anjali Raghuram, MD MBA; Tiffany Jeong*, BS; Beth R. Gusenoff, DPM; Jeffrey A. Gusenoff, MD
Department of Plastic Surgery, University of Pittsburgh School of Medicine, Sewickley, PA
Purpose: Forefoot and heel fat pad atrophy are debilitating conditions in which the fat compartments of the foot are either displaced or degenerate. While the authors have previously demonstrated that autologous fat grafting is a safe, effective treatment for improving pain and quality of life, there is a lack of long-term studies exploring quality of life. This study aims to assess the long-term outcomes of autologous foot fat grafting.
Methods: A cross-sectional survey was conducted for patients who presented to the UPMC Department of Plastic Surgery between July 2015 and June 2018 for autologous foot fat grafting. At the time of initial treatment, patients received fat grafting immediately (interventional cohort) or after one year (cross-over cohort). Patients were queried using the validated Manchester Foot and Disability Index at initial, last office visit, and at the time of this study. Statistical analysis included Fisher's Exact, Wilcoxon Rank-Sum, and two factor ANOVA tests.
Results: A total of 25 respondents were included (response rate 69.44%; 14 interventional, 11 cross-over). Median age was 63 (IQR: 10) years. Average follow-up was 8.98 (SD: 1.21) years. Time was associated with improved heel function (p = 0.021). Heel pain, appearance, and work/leisure scores were not associated with time (p = 0.210, p = 0.054, p = 0.890). Regarding forefoot, time was associated with improved aesthetic perception of the feet (p < 0.001). Time was associated with worsening forefoot functional scores (p = 0.020). No difference was observed for forefoot work/leisure nor pain scores (p = 0.053, p = 0.159).
Conclusion: Patients who received fat grafting to the heel experienced lasting improvements to foot function nearly 10 years post-procedure; those that received forefoot grafting had the opposite effect. Nevertheless, both forefoot and heel fat grafting contributed to maintained pain relief for patients. Future studies should aim to elucidate which forefoot types benefit the most from treatments, and who may benefit from additional injections over time.
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