Background: Fat pad atrophy is the loss of subcutaneous tissue in the plantar foot, inhibiting the cushioning function. Patients experience severe pain on ambulation from high-pressure forces. Soft-tissue augmentation, or fat pad restoration, is performed to improve the thickness and cushioning ability of the subcutaneous layer. The first of its kind, allograft adipose matrix (AAM), which has been reported to support native fat pad restoration, was evaluated to address fat pad atrophy and the cushioning ability in the plantar foot.
Methods: An institutional review board–approved retrospective study review and analysis of 16 patients (21 feet) treated with AAM in the plantar foot was conducted. Adverse events and a subjective patient evaluation of percentage improvement were reported, sometimes supported by imaging.
Results: The mean ± SD volume of AAM injected was 2.2 ± 0.7 mL (range, 1.5–2.6 mL), with a follow-up time of 3 to 20 months, in patients with a mean ± SD age of 68.6 ± 8.9 years. Overall minimal adverse events were observed, and the mean ± SD percentage improvement, as per patient feedback, was 72.9% ± 23.0% (100% corresponds to fully satisfied). The quality of skin improved with reduced presence of callus, and patients resumed their daily activities.
Conclusions: An AAM can support endogenous fat pad restoration by supplementing fat thickness and its natural cushioning ability. The early clinical observations in this retrospective study review demonstrated that patients could resume daily activities after treatment.
After resection of bone or amputation, postoperative stump breakdown occurs frequently. Furthermore, the altered mechanics with ambulation are difficult to control with bracing and orthoses alone. During the past 10 years, the peroneus brevis tendon has been transferred to various locations in the foot after resection of the fifth metatarsal base in an effort to provide continued balance between the supinatory and pronatory forces needed for a steady gait. In patients who have had a peroneus brevis tendon transfer, the rate of postoperative ulceration and the need for further bony resection is minimal. Analysis of the biomechanical influences and effects of different anatomical placements of the transferred tendon reveals the importance of transfer of the peroneus brevis tendon. (J Am Podiatr Med Assoc 94(6): 594–603, 2004)