Emerging Concepts In Cosmetic Foot Surgery

Start Page: 70
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Author(s): 
Allan Grossman, DPM, FACFAS, Jason Sweeley, DPM, Ann Nakai, DPM, and Jeff Merrill, DPM

What You Should Know About Fat Pad Injections

Fat pad injections are another practice that is gaining momentum. The plantar fat pad absorbs much of the pressures that our feet must endure. However, over time, this fat pad wears down and the cushion that we enjoyed in youth flattens. This causes painful calluses and areas that can lead to more serious complications such as ulcerations in some patients. Some of the more conservative approaches to dealing with this unpleasant certainty of fat pad atrophy include orthotics, gel cushion inserts or changes in shoe gear.

   There has also been a large movement to inject silicone to the atrophied sites that has shown success. A randomized, double blind, placebo-controlled study showed that plantar silicone injections reduced the risk factors related to diabetic foot ulcers although follow-up studies have confirmed that the results do not last long and the patient requires multiple injections.14

   Autologous fat can augment plantar fat pad atrophy with some relative success. In 2009, Rocchio used GraftJacket (KCI), an acellular human dermal allograft, to augment the plantar fat pad.15 According to the author, this method solves the problem of fat pad atrophy in the patient with diabetes “permanently and practically.”

   With the relative success of silicone injections and the new possibilities of GraftJacket, the practitioner and surgeon have new and exciting possibilities to turn back the clock and give patients a soft step to the future.

Final Words

While there are many surgeons who offer cosmetic foot surgery, we feel that patients should not enter into surgery for the sole purpose of cosmesis. One should only attempt surgery when pain interferes with daily activities, when all conservative treatment has failed or when the condition threatens life or limb. While all surgery carries an inherent risk, there is an especially high risk with cosmetic surgery in the foot and ankle from the standpoint that we rely on our feet so much during daily activities. Complications from surgery can be debilitating.

   One should always weigh the risks versus the benefits of the surgery. It is our opinion that the risk always outweighs the benefit when it comes to cosmetic procedures of the foot and ankle.

   Dr. Grossman is a Fellow of the American College of Foot and Ankle Surgeons, and a Diplomate of the American Board of Podiatric Surgery and the American Board of Podiatric Orthopedics. Dr. Grossman is a member of the teaching faculty with the Pinnacle Health System and is in private practice in Harrisburg, Pa.

   Dr. Nakai is a third-year resident with the Pinnacle Health System in Harrisburg, Pa.

   Dr. Sweeley is a third-year resident with the Pinnacle Health System in Harrisburg, Pa.

   Dr. Merrill is a first-year resident with the Pinnacle Health System in Harrisburg, Pa.

References

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