Fat Transfer to the Heel Area?

Question

I have had a total of 3 steroid injections to the bottom of my left foot over a period of 3 years for plantar faciaitis. I now have some atrophy of the fatty tissue which is more painful than the heel spur was. Is there any treatment for this? I've heard that fat injections from other locations on the body is an option. If so, how helpful is this in relieving the pain?

Otto Joseph Placik, MD · Answer

The use of injections to the heel is generally practiced by Podiatrists and not orthopedic ankle and foot specialists.
I am aware that some prefer Radiesse for this purpose but this really depends on the experience of your treating practitioner.
Although adipose tissue (fat) is easy to put on, it is an extremely delicate tissue and not entirely predictable in its behavior. Injection generally demands that you over inject in order to achieve a desired result.
The heel is exposed to repeated trauma, stress, and weight and the foot does not have as good a blood supply muscle mass all of which combine to making the area less than optimal for take of the fat graft.
I would seek a podiatrist with experience in this area and contemplate this modality only if you are in otherwise excellent health and are a non-smoker.

Robert M. Freund, MD · Answer

I do not perform these procedures, but know that fat needs limited motion and minimal trauma to survive. I guess it can work in the foot, but would expect a lot of bedrest for ultimate success.

Pat Pazmino, MD, FACS · Answer

Although it is possible to transfer factor the heel this is extremely uncommon. If you have a concern about her heel and if this tissue has suffered damage from multiple injections of steroids in this area, keep in mind that this tissue is no longer no normal heel tissue. The steroids have currently affected the tissue and have made them difficult to seal and much thinner than normal. Going forward, it is extremely important to work with a board-certified plastic surgeon with a great deal of experience with fat injections, slap techniques, and reconstruction of lower extremity. There are several options that are available for you but fat injection may not be the best one.

Hisham Seify, MD, PhD, FACS · Answer

Fat is a great material to use to be able to fill defects. However, using it in the heel is very different. If the injection needs to be done in the area of weight bearing(heel or base of toes), there is a high chance for resorption due to pressure necrosis.If the instep is to be injected, there is a better chance for survival. Hope that helps.

Fat Transfer to the Heel Area?

Answers (4)