• Posted January 26, 2022

Fat Injections Might Ease Pain of Plantar Fasciitis

Belly fat is usually unwelcome, but new research suggests it may actually be good for something: relief from foot pain.

A small pilot study suggests that an injection of a patient's own fat cells can help ease the often-excruciating heel pain brought on by a condition known as plantar fasciitis.

"We take a small amount of fat from an area of excess -- like the belly, inner thigh or love handles -- and then inject the fat into the bottom of the foot near where the fascia inserts into the heel bone," explained study co-author Dr. Jeffrey Gusenoff. The arch-supporting fascia is a ligament that runs from the heel to the toes.

The minimally invasive outpatient procedure is performed under local anesthesia, said Gusenoff, a professor of plastic surgery at the University of Pittsburgh School of Medicine, in Pennsylvania.

Among the 14 patients in the study, the procedure produced a notable "reduction in plantar fascia thickness and significant improvements in pain and quality of life," said Gusenoff. "Many people returned to activities they had given up in the past, so the improvement was significant for many in terms of being on their feet."

Plantar fasciitis is a common inflammatory condition, affecting more than 2 million Americans, said Beth Gusenoff, study co-author and wife of Jeffrey Gusenoff.

"About one in every 10 people will develop plantar fasciitis in their lifetime," added the clinical assistant professor of plastic surgery at the university.

There are many triggers, she said. Those include: excessive foot stretching; routinely putting too much weight on the inside edge of the foot; weight gain; overuse; excess exercise; pregnancy; and/or tight tendons.

For people with a seriously inflamed plantar fascia, the result is often "a searing, sharp-type pain like a 'nail' or 'needle' going right through their heel bone when they first rise from a seated position, or when they first wake in the morning," Beth Gusenoff said. "As they walk and warm up the plantar fascia, and make it more flexible, the pain eases, but will begin throbbing again by the end of day."

About nine in 10 patients will do well with standard treatments, she noted. Those include shoe orthotics, cortisone injections, stretching techniques, shockwave therapy, laser treatment and, in some cases, a small surgical incision aimed at "releasing" the fascia.

But sometimes surgery can prove destabilizing and/or give rise to painful scar tissue, she noted. And for the 10% of patients who develop a chronic condition -- called "plantar fasciosis" -- standard interventions often fail to provide relief.

So the husband-wife team set out to fashion a less risky and more effective intervention focused on fat.

First, they use a blunt needle to pierce the fascia. Then they inject the patient's own fat into the injury site.

Why fat?

Fat is packed with stem cells and growth factors that can prompt a "regenerative" in-flow of fresh blood, the Gusenoffs explained. That, in turn, can speed up the healing process, with minimal pain-inducing scarring.

To test their approach, the duo split their 14 patients into two groups. One group underwent a single fat injection before being tracked for a year; the other underwent six months of observation before getting the injection, and was then tracked for six months.

Each group saw reduced plantar fascia thickness and was better able to engage in sports activity, both six and 12 months after the injection.

However, significant pain reduction was only seen in the 12-month post-injection group, not among the six-month group.

"It is possible that if we followed these participants out further, they would have had results similar to the one-year group," said Jeffrey Gusenoff. "The regenerative process of the fat on the tissue likely takes a long time, so the results continue to get better with time."

The procedure is still considered experimental, while the team prepares to conduct larger studies.

Wenjay Sung, a Los Angeles-based podiatrist, expressed enthusiasm for the study findings.

"This condition is the second-most common reason to see a doctor in the United States, the first being cold/flu symptoms," said Sung, a physician spokesperson for the American Podiatric Medical Association.

"It's great to recognize newer treatments and effective approaches when dealing with a chronic condition such as heel pain," Sung said.

Still, he cautioned that the findings will need to be repeated by other researchers. "And increasing the pool of patients will give it more credibility," Sung said. "I look forward to future studies and their results."

The study was published in the February issue of Plastic and Reconstructive Surgery.

More information

There's more on plantar fasciitis at the Cleveland Clinic.

SOURCES: Jeffrey Gusenoff, MD, professor, plastic surgery, University of Pittsburgh School of Medicine; Beth R. Gusenoff, DPM, FACFAS, clinical assistant professor, plastic surgery, University of Pittsburgh; Wenjay Sung, DPM, podiatrist and physician spokesperson, American Podiatric Medical Association, Los Angeles; Plastic and Reconstructive Surgery, February 2022