The Northeastern Society of Plastic Surgeons

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PERFORATING FAT INJECTIONS FOR CHRONIC PLANTAR FASCIITIS: A NOVEL REGENERATIVE TREATMENT OPTION
Wendy Chen, MD, MS, Beth Gusenoff, DPM, Sanja Sljivic, DO, Gabriella DiBernardo, BS, Danielle Minteer, PhD, Jeffrey A. Gusenoff, MD.
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

BACKGROUND: Plantar fasciitis (PF) is the most common cause of heel pain, and chronic PF is a painful condition resulting from recurrent inflammation and degeneration of the plantar fascia insertion at the calcaneal tuberosity. Fascial thickening can cause tremendous pain and reduce quality of life. Current treatment options can be invasive, with complication risks, or non-invasive with inconsistent results. We evaluated a novel method of perforating fat injections to regenerate the plantar fascia and reduce pain and improve quality of life.METHODS: We report a prospective, randomized cross-over pilot study. Included patients had chronic PF with thickening (>4mm) and failed standard treatment for 6 months. Subjects were randomized to either observation or intervention groups. Intervention involved perforating autologous fat injections to the PF at multiple sites. Subjects were evaluated at baseline, 1-/2-/6-months. Outcomes included validated foot pain and function questionnaires, plantar fascia thickness, and physical exam. Unpaired t-test was used (p<0.05).RESULTS: 15 human subjects were enrolled and randomized (14 female; mean age 49.912.4 years, mean BMI 29.14.8; observation, n=6; intervention, n=9) following a diagnosis of chronic PF for >4 years. Mean injection volume was 2.61.6 cc/foot. At baseline, there were no significant differences between the groups. Six and 12 months after intervention, experimental group had significantly less thick plantar fascia measured by ultrasound (p<0.05), while the observational group displayed no change in plantar fascia thickness (p>0.05). The experimental group had improvements in pain at 1, 2, 6, and 12 months post-operative (p<0.05) while the observational group reported the same pain levels compared to pre-op at 1 and 2 months (p>0.05), then improvement at 6 months after the procedure (p=0.03). Both groups reported improved functionality following the procedure (p<0.05). No unanticipated complications occurred. CONCLUSION: Perforating fat injections to the plantar fascia demonstrate promising improvements in pain and daily activities. Autologous fat grafting proves to have a regenerative potential in remodeling chronically thickened plantar fascia and eliminating pain.


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