Plantar Fat Grafting and Tendon Balancing for the Diabetic Foot Ulcer in Remission

Lower extremity complications of diabetes constitute a common, complex, and costly condition with morbidity rivaling many forms of cancer.1 The term “remission” is commonly used after healing to better describe the high likelihood of recurrence in this population.2,3 As a strategy to reduce the severity of recurrence and extend ulcer-free days of activity, investigators have explored a variety of approaches to augment the plantar fat pad.4 Regional fat augmentation or “lipofilling” using autologous fat has been previously described as a means of supplementing defects and preventing regional atrophy throughout the body, including its uses as an adjunct to wound healing and to mitigate pain in the foot.5,6–8 However, we are unaware of any reports in the literature that have described its use in the high-risk diabetic foot in remission. Herein, we report on the use of free fat grafting as a means of redistributing normal and shear stress after healing of plantar diabetic foot wounds and a review of the literature of this approach. We successfully performed autologous fat grafting from the abdomen to augment the plantar fat pad without apparent adverse effects or recurrence.