Treating foot pain
Pitt researchers develop new procedure
University of Pittsburgh School of Medicine researchers have developed a new technique to help people suffering from plantar fasciitis, a painful foot condition.
The researchers, a husband-and-wife team, came up with a way to transplant fat taken from another part of a patient’s body into the soles of the feet. Their findings from a pilot study — which showed that the procedure improved symptoms of plantar fasciitis in 14 patients — were published at the end of January in the journal Plastic and Reconstructive Surgery.
Dr. Jeffrey Gusenoff, professor of plastic surgery at Pitt, and Beth Gusenoff, clinical assistant professor of plastic surgery, say they are planning a larger clinical trial to validate these findings. Danielle Minteer, formerly a researcher at Pitt, was an additional author.
Because the study is only in its initial phase, the procedure is not covered by insurance companies. It costs about $3,500 per foot.
Plantar fasciitis is caused by inflammation around the plantar fascia, the connective tissue that connects the heel bone to the toes and supports the foot arch. According to the American Academy of Orthopedic Surgeons, approximately two million patients are treated for this condition every year, making it one of the most common causesof heel pain.
Ms. Gusenoff said about one in ten people will experience plantar fasciitis in their lifetime. However, there are two types of the condition — acute and chronic. She said about 10% of the time, the condition will worsen from the more mild acute form to chronic, where the foot’s collagen degenerates and the plantar fascia thickens.
The acute form of the condition can be caused by factors such as weight gain and the patient’s foot type, as well as “tight tendons, which comes with age, overuse, injury, or not wearing supportive shoes, barefoot, flip-flops, ballet flats,” she said. “So all this can bring on plantar fasciitis, and if it doesn’t get treated, or if it just continues to repeat it becomes chronic plantar fasciitis. Then it’s no longer inflammation — the plantar fascia actually changes in its consistency and it sometimes becomes thickened, almost like scar tissue.”
While the acute form can be treated using stretching, shoe orthotics or cortisone injections, the chronic form typically warrants a surgery to release the plantar fascia with a small cut.
The Gusenoffs’ procedure focuses on treating the chronic form of the disorder by harvesting fat from a patient’s belly or body area and transplanting it to the foot.
“In fat, there are stem cells and growth factors that help bring in fresh blood supply, which drives a mode of wound healing with reduced scarring,” Dr. Gusenoff said. “We use a blunt needle to perforate the plantar fascia, which makes a small injury to stimulate the healing process. Then, when we pull the needle back, we inject a little bit of the patient’s fat.”
To test their idea, the team recruited 14 patients with chronic plantar fasciitis and split them in two groups starting in 2017. Participants in group one received the procedure at the beginning of the study and were followed for 12 months, and their counterparts in group two received the procedure after a six-month observation period and were followed for an additionalsix months.
“We found that group one had improvements in quality of life and sports activity, decreased plantar fascia thickness and reduced pain levels,” Dr. Gusenoff said. “And a lot of the measures that were improving six months after the procedure got even betterby 12 months.”
Group two showed decreased plantar fascia thickness and increased sports activity six months after the procedure, and there was a slight, but not statistically significant, improvement in pain levels. With a larger sample size and a longer follow-up time, the researchers said it’s likely they would have seen stronger improvements in this group.
Melissa Pickett, 63, of Point Breeze, was one of the patients who received this procedure in May 2018. She was the last person to join the study. Ms. Pickett is very active — she often walks five miles a day, bikes 60 to 80 miles a day or lifts weights — and she didn’t want to stop exercising after developing chronic plantar fasciitis. So, after seeing many doctors, she found the Gusenoffs’ procedure online, and decided it was the best option for her.
She said they took about a spoonful of fat from her stomach and injected it into both of her feet, which wasn’t painful. However, when she got up to walk, she said it felt like she “had two footballs for feet.” The procedure itself only took a few minutes from start to finish.
Ms. Pickett said that for about one year after the procedure, she experienced some pain and used a brace to get around.
“At one point, I just thought, did I do the wrong thing? Did I do the wrong thing? But as my foot began to heal, it got better and better,” Ms. Pickett said. “You just have to be patient with it.”
Now, more than three years after the surgery, Ms. Pickett said she’s back to running, biking and lifting weights. Sometimes there’s pain, but she said she would still recommend the procedure to anyone — especially to people who are athletic.
“I could not be more thankful for [the procedure], because I am walking around a normal person,” she said. “It brings tears to my eyes because I know how much it helped me.”