SLR - January 2024 - Namous
Title: A New Minimally Invasive Procedure for Treating Plantar Heel Pain Stromal Vascular Fraction Gel GraftingReference: Ann Plast Surg 2023 Nov 1;91(5):609-613. doi: 10.1097/SAP.0000000000003651. Epub 2023 Aug 31.
Level of Evidence: III
Scientific Literature Review
Reviewed By: Ahmad Namous, DPM, PGY-3
Residency Program: University Hospital, Newark, NJ
Podiatric Relevance: Heel pain is one of the most common pathologies encountered in podiatric medicine and surgery. Some of the most common causes of heel pain are fat pad atrophy and plantar fasciitis. This article describes a technique of harvesting and injecting stromal vascular fraction gel grafting (SVF gel) for the treatment of heel fat pad atrophy and plantar fasciitis.
Methods: This is a retrospective analysis of patients who underwent SVF gel grafting for treatment of heel fat pad atrophy and plantar fasciitis between January 2019 and June 2020. There was a total of 14 patients, 9 women and 5 men. 3 patients had plantar fasciitis and 11 had fat pad atrophy. Patients with diabetes were excluded. Fat was harvested from the lower abdomen and inner thigh via liposuction. The harvested adipose tissue was centrifuged for 3 minutes. After collecting the middle layer, it was then used to obtain the SVF gel via mechanical emulsification. The emulsified middle layer was again centrifuged for another 3 minutes and the SVF gel was separated from the oil. 1mL injected into the most painful area, and an additional 4mL was injected diffusely in the heel.
Results: There were no reported complications, most patients had donor site ecchymosis and heel edema which resolved within 2 weeks. Chinese Manchester Foot Pain and Disability index (MFPDI) scores were given to each patient at 3, 6, and 12 months. MFPDI scores were lower in function pain, and appearance, indicating improvements. At three months there was statistically significant improvement in pain and function from baseline. There was no statistically significant difference at 6 and 12 months. MRI was used to measure fat pad thickness at baseline, 3 and 12 months postoperatively. Heel pad thickness was significantly thicker at 3 months compared to baseline, but no difference between 3 and 12 months.
Conclusions: SVF gel contained adipose extracellular matrix, functional cells and ADSCs (adipost derived stem cells), which have high retention rate and low inflammatory response. Traditional fat transplantation has a high resorption rate. SVF gel transplantation is an effective treatment for heel pain secondary to fat pad atrophy and plantar fasciitis. Limitations to the study include lack of control, its retrospective nature, and small sample size.