Autologous Fat Grafting to the Plantar and Dorsal Aspect of the Foot – Function and Aesthetics

Image Credit: Journal of Aesthetic and Reconstructive Surgery 

Authors: Gordon Slater| Tandose Sambo

“The human body has been designed to resist an infinite number of changes and attacks brought about by its environment. The secret of good health lies in successful adjustment to changing stresses on the body.” – Harry J. Johnson

Autologous fat transfers have been utilized over the past few decades to facilitate the healing and restoration of the health of the feet. The process of fat transfer to the feet is one that has resulted in pain free mobility for the patients with loss of fat in places like the pedal foot, and even in the surface regions of the feet. Fat pad restoration on the plantar (sole) aspect of the feet have extensively been conducted, the orthopaedic realm is now making progress towards the transfer of fat to the dorsum  (upwards surface) of the feet. 

Fat transfers to the plantar foot have proven effective in minimising and eliminating pain, and increasing the mobility of the patient. The medical benefits of this activity are well validated. Fat transfers to the dorsum however, is an aesthetic and cosmetic procedure. For a variety of reasons, patients would have the desire to improve the appearance of their feet, in order to feel more confident in situations that require them to go barefooted. As social people, we do love to take time out to be with family and friends in locations such as the beach or the pool, and feeling comfortable in our appearance is key to self confidence. 

FACTORS THAT WILL INFLUENCE DORSAL FAT GRAFTS 

As patients, you may want to improve both the function and aesthetics of your feet. 

During orthopaedic research, various patients have got through the process of improving both the foot function and aesthetics of their feet via the process of autologous fat grafts. For the soles of the feet, the fat grafts are incorporated to provide the relevant cushioning of the feet. From the image above, you can clearly see that a fat transfer to the dorsal aspect of the foot, will improve the appearance. 

In plastic surgery, autologous fat transfers are mainstream procedures that are incorporated into the healing process. The process utilizes both microfat and nanofat to sculpt the body into the desired features. For the feet, the fat transfers will camouflage the tendons and veins, and provide support to the thinning skin. With time, the degeneration of the body is expected, these healing mechanisms are designed to actually restore these internal changes. 

CANDIDATES FOR AUTOLOGOUS FAT GRAFTS 

The best way to identify if you are a candidate that will be considered for autologous fat grafts, is to consult with your orthopaedic specialist. Via an inspection, and understanding of your medical history, the procedure for restoration of the function and aesthetics of your feet will then be determined. In some instances you may require both procedures. According to our listed reference, a 55 year old female with a history of peripheral neuropathy induced by cervical spinal injury and gynaecological surgery expressed an interest in an autologous fat transfer. 

With initial assessment, her doctor identified that she was a smoker, and with that condition is an additional risk of limited recovery. If you too are in this category, you can take note of the fact that smoking does have an impact on the vascular system and ultimately the health of the feet. 

With time, the patient had experienced plantar fat pad atrophy. Her description of her pain was identified as: 

 “pounding that was placed on her heels and the balls of her feet with each step”. 

Many patients feel as if they are walking on their bones, and the weight and pressures on the feet do make walking an activity that is painful. The patient ultimately had to reduce her activities because of the pain that she was in. In the case study, the patient had attempted previous attempts to restore her feet that included cortisone injections, orthotics, physical  and shoe inserts. When attempted, they did not seem sufficient to improve her condition. Additionally her feet were experiencing the symptoms identified above and the cosmetic appearance was of concern to the patient. 

When her vascular system was assessed, the patient’s system was found to be in good condition. Her skin was also healthy. 

TREATMENT PLAN 

The patient was ultimately evaluated, and a plan of treatment devised by her orthopaedic specialist. The treatment plan involved a fat transfer to both the plantar and dorsal region of the feet. 

Autologous Fat Grafting Procedure

Autologous fat grafting is an emerging technology that is being used to treat pedal fat pad atrophy. This process involves a fat transfer from other parts of the body, and injecting those fat extractions into the bottom of the feet. The grafting process began approximately three decades ago, but with all technologies, there’s a curve that is involved in the understanding of the best approaches to utilize in patients in order to achieve results. With time, limitations of the technology were overcome. 

Successful transfer of fats harvested from the abdomen of patients has proven to be successful in the restoration of patient pedal fat pads that were affected by previous injuries. With a thickening of the heel fat pad, the restoration of the plantar sole was achieved. The patients were able to resume normal weight bearing capability. For the patient an autologous fat transfer was performed with a local anaesthetic. 

The procedure involved an initial liposuction to access the fat to be transferred to the feet. The fat was then centrifuged in order to extract the relevant components for reinjection. The harvested fats were reinstated into the plantar regions of the feet, as well as the soles. The approaches for injection differ from each perspective. 

The process was successful, and the patient has recovered in a normal fashion. Fat pad restoration for both aspects of the feet have proven to enable an improvement in the mobility of the patients who have been treated. From a functional perspective, the comfort of walking is greatly improved, and the youthful appearance of the feet is one that improves the confidence of the patients.

Article Reference: 

  1. Journal of Aesthetic and Reconstructive Surgery: https://aesthetic-reconstructive-surgery.imedpub.com/autologous-fat-grafting-to-the-plantar-and-dorsal-aspect-of-the-foot-for-two-varying-indications-a-case-presentation.pdf

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Dr. Gordon Slater

Dr. Slater is one of the first foot and ankle surgeons in Australia to adopt minimally invasive surgical techniques. He routinely uses MIS to treat a range of conditions, including bunions.

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Dr Gordon Slater is a highly-skilled surgeon specialising in foot and ankle conditions and sports injuries. Dr Slater is one of the first foot and ankle surgeons in Australia to adopt minimally invasive surgical techniques. He routinely uses MIS to treat a range of conditions, including bunions. MIS  has many advantages including shorter operating times, reduced post-operative pain, reduced risk of infection, minimal scarring and better cosmetic outcomes.

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