A Step in the Right Direction: A Prospective Randomized, Controlled Crossover Trial of Autologous Fat Grafting For Rejuvenation of the Heel.

BACKGROUND The shock-absorbing soft tissues of the heel are composed of dermis and specialized fat pads. Heel fat pad atrophy (FPA) is common and can be painful and debilitating. In our previous work, autologous fat grafting (AFG) was effective for treating pain from forefoot FPA. OBJECTIVES We hypothesized that AFG to the heel would relieve pain and improve function in patients with heel FPA. METHODS Patients with heel FPA and associated pain were recruited and randomized into two groups. Group 1 received AFG upon enrollment and was followed for 2yrs. Group 2 received offloading and activity modification for 1yr, then crossed over, underwent AFG, and was followed for 1yr afterward. Outcome measures included ultrasound-measured fat pad and dermal thickness, pedobarograph-measured foot pressures and forces, and patient-reported outcomes as measured by the Manchester Foot Pain and Disability Index (MFPDI). RESULTS Thirteen subjects met inclusion criteria and completed the study. Seven (12 affected feet) were randomized into Group 1, and six (9 affected feet) were randomized into Group 2. Average age was 55yrs and BMI was 30.5kg/m 2. Demographics were not significantly different between groups. Heel fat pad thickness increased after AFG but returned to baseline at 6mo. However, AFG increased dermal thickness significantly and increased fat pad thickness under compressive load compared to controls at 6-12mo. Foot pain, function, and appearance were also significantly improved compared to controls at 6-12mo. CONCLUSIONS AFG improved patient-reported foot pain, function, and appearance and may rejuvenate local soft tissues in patients with heel FPA.