Patient Characteristics Predict Success Following Pedal Soft Tissue Augmentation

Abstract

INTRODUCTION: Pedal fat grafting has been shown to improve pain and functional impairment from forefoot fat pad atrophy. We aim to determine whether patient demographics and foot characteristics play a role in the level of impact that is achieved following surgery. METHODS: We performed a retrospective review of patients who received forefoot autologous fat injections for the treatment of pedal fat pad atrophy. Patient improvement of pain and functional impairment was measured using the Manchester Foot Pain and Disability Index. One-way analysis of variance statistical analyses were used to evaluate correlation between patient characteristics and an improvement in survey scores assessing pain and functional impairment from the time of surgery to 6 months, to 12 months, and from 6 to 12 months. Patient characteristics examined include gender, age, body mass index (BMI), unilateral or bilateral injections, a flexible or rigid foot arch, previous foot deformity or surgery, and the presence of callus. RESULTS: Forty-four patients received fat injections into the ball of their foot. Seventy-three percent of them were women; their mean age was 61 years old, and mean BMI was 26.6 kg/m2. Seventy-five percentage had injections performed bilaterally. Forty-one percentage had a flexible arch, 73% had a history of pedal deformity or surgery, and 43% had callus. Significant findings included a correlation between female gender and an improvement in pain from the time of surgery to 12 months later (P = 0.02), a correlation between unilateral injections and an improvement in pain from the time of surgery to 6 months later (P = 0.03), and a correlation between a healthy BMI and an improvement in functional impairment from 6 months postsurgery to 12 months postsurgery (P = 0.01). CONCLUSION: Patient characteristics correlate with the impact of pedal fat grafting surgery and the time course of improvement following surgery. Female gender was found to correlate with improvement in pain at 12 months postsurgery. Patients undergoing unilateral foot fat grafting may see clinical improvements in pain faster than those receiving bilateral injections. Ultimately, both groups see clinical improvement at 1 year. Similarly, patients classified as overweight may see faster improvement in functional impairment than those with lower BMI with no difference at 1 year. Given our findings, we advocate for all patients with suspected fat pad atrophy to be considered for soft tissue augmentation. Large-scale studies are called for to further elucidate the impact of various patient characteristics on the probability of success in pedal fat grafting.