Fat transfer for plantar heel pain: A retrospective case series

Plantar heel pain (PHP) affects 4-7% of the population. It encompasses a range of different pathologies. Heel fat pad atrophy is thought to be the second leading cause of PHP. Atrophy of the heel fat leads to decreased cushioning over the calcaneus. The associated pain can be disabling and lead to reduced mobility and social isolation. This case series describes how fat transfer can alleviate symptoms of PHP.

Twenty-one procedures of fat transfer were performed using the Coleman technique for PHP between 2013 and 2023. All surgical candidates had clinical and/or radiological evidence of heel fat pad atrophy and suffered with intractable PHP. Other pathologies including plantar fasciitis were excluded prior to surgery. All surgical candidates undertook the Manchester-Oxford Foot Questionnaire (MOXFQ) Patient Reported Outcome Measure prior to surgery and at 3 months postoperatively. Average patient follow-up was 6.5 months.

The median preoperative MOXFQ Index score was 70.5 (Interquartile range = 7.0). The median postoperative MOXFQ score was 33.0 (Interquartile range= 21.5). The median reduction in MOXFQ Index score was 37.0 (Interquartile range 27.5). Wilcoxon signed-rank test confirmed a statistically significant reduction in MOXFQ scores (p < 0.00001). Power analysis revealed an effect size of Cohen's d = 2.03, with a statistical power of 1.0. There were no cases of reoperation. There were no recorded postoperative complications.

This case series study highlights the potential efficacy of autologous surgical fat transfer in alleviating intractable PHP associated with heel fat pad atrophy. This case series is limited by its small sample size and long study window. Despite initial and promising results, further research evaluating a larger cohort is warranted.