Pittsburgh doctors try treating plantar fasciitis with a shot of fat
More study is needed, but a small trial yielded promising results.
Can a teaspoon of body fat alleviate the pain of chronic plantar fasciitis?
For Melissa Audain Pickett, a recently retired Pittsburgh elementary teacher, the answer is yes. An avid cyclist, walker, and weight lifter who developed debilitating pain from chronic plantar fasciitis, Pickett found relief as a participant in a University of Pittsburgh Medical School clinical trial, where she received an injection of her own body fat into the soles of her feet in May 2018.
“The pain was so awful that I tried to walk on the sides of my feet,” Pickett said. A former gymnast and participant in track and field, before developing chronic plantar fasciitis Pickett often walked 48,000 steps in a day and could regularly bicycle 50 to 90 miles.
After she developed the condition, she worried about walking long distances outdoors because the pain might leave her stranded, unable to return home by foot.
Plantar fasciitis, an inflammation of the thick band of tissues that connect the heel bone to the toes, affects three million people in the United States. As the most common cause of foot pain, the condition can spring from a variety of conditions, including weight gain, pregnancy, age, high arches, overuse, and even non-supportive footgear.
People with plantar fasciitis experience intermittent bouts of severe stabbing heel pain.
“It’s exceptionally painful,” said Beth Gusenoff, clinical assistant professor of plastic surgery at Pitt, who along with her husband, Jeff Gusenoff, professor of plastic surgery, ran the proof-of-concept study. “When you get up from a sitting position or from sleeping, it’s a sharp searing pain that some people describe as being like a nail going right through their heel.”
Treatments for the condition include steroid injections, ice, stretching, physical therapy, and orthotics. But, in about 10% of cases, plantar fasciitis like Pickett’s can turn chronic, where the foot’s collagen degenerates and the plantar fascia becomes scarred and thickens.
Current surgical treatments include making a small cut in the plantar fascia to reduce and release the tension of scar tissue in the foot. But although the procedure may ease pain, it has the danger of leaving a patient with a “droopy foot,” where walking becomes unstable.
In search of a less problematic treatment, the Gusenoffs turned to options that employed the regenerative properties of body fat to reduce chronic inflammation and scarring in other forms of fibrosis, such as in Duchenne contracture, a tightening of the finger cords which causes fingers to be bent down, cases of fibrous scarring after burns, and breast scarring following cancer radiation.
“Fat has been gaining a lot of popularity for a lot of indications because its stem cells and growth factor bring in a new blood supply and drives a different regenerative healing process rather than creating a bunch of scar tissue,” Jeff Gusenoff said.
During the clinical trial, two groups of patients received an injection of their own body fat into the underside of the heel where the plantar fascia meets the bone. Fat was taken from the stomach or hip area.
Twelve patients in the first group received the shot at the start of the trial, while the second control group received their first injection six months later. Findings showed that the first group had a narrowing of the width of the fascia, indicating less scarring, pain reduction, and a return to normal activities at six and 12 months. The control group experienced no improvements during the six months before their injections but improved markedly after receiving the shot.
“The injections aren’t very invasive or painful,” said Beth Gusenoff. “Patients have a little bruising, but nothing compared to the pain that they’re already living with.”
During the recovery period, which takes about a year, patients are urged to reduce strenuous activities and to avoid walking barefoot.
With the success of the proof-of-concept study, the Gusenoffs hope to receive NIH funding for a larger, more comprehensive trial.
For Pickett, the injection has been life-changing.
“I didn’t know what I was going to do,” she said. Her search for pain relief had led her to try night braces, ice packs, and physical therapy without success.
After receiving the injection, she initially felt as though she were “walking on footballs” and had to learn to balance her stride. But after about two years of steady improvements, she’s back to walking up to 20,000 to 30,000 steps a day.
And, most important, she walks without pain.
“My healing time was longer than everyone else’s but I’m so glad to be normal now,” she says. “It doesn’t make sense to walk around in that much pain all the time. No one should live life like that.