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why can't heel pad fat be replaced?

Posted by Linda V. on 8/19/04 at 17:23 (158430)

hi,
modern science can transplant so many things...has there been any studies to see if 'heel pads' can be reconstucted either with transplants from other areas of fatty tissue from the person or even a collagen type injection?
i mean..we can put a man on the moon...and do double lung transplants. why can't FEET get fixed?
linda v

Re: why can't heel pad fat be replaced?

Dr. David S. Wander on 8/19/04 at 19:36 (158435)

Fat injections were attempted many years ago and failed. The fat was taken from the calf or other donor sites and injected into the bottom of the foot. The idea was started by Ed Chairman, DPM in Philadelphia and did not work.

Re: why can't heel pad fat be replaced?

Pauline on 8/19/04 at 19:51 (158437)

Dr. Wander,
Why do you think it's become so popular now? It it didn't work then, why should it work today. The only thing I can think of is that since most of our society is overweight maybe the 'fat' is a better quality:*

Re: why can't heel pad fat be replaced?

Darlene on 8/19/04 at 21:31 (158441)

A podiatrist in Phoenix told me a few months ago that they are very close to having success. I think he was referring to someone else's research, not his own.

Re: why can't heel pad fat be replaced?

Dr.David Wander on 8/20/04 at 08:39 (158453)

I am not aware of any successful 'fat' transplants to the foot. Remember, the foot is unique since it undergoes considerable stress and pressure on a daily basis. There is a podiatrist, Dr. Sol Balkin that has been using silicone injections for many years. This is an 'off label' use, but Dr. Balkin relates significant success. Years ago collagen injections were also utilized (Keragan) without much success. The injections were not covered by insurance, were expensive and had to be repeated. Once again, as of now I am not aware of any injection therapy or fat replacement therapy that has been successful or has stood the test of time for use in the plantar aspect of the foot.

Re: why can't heel pad fat be replaced?

Ed Davis, DPM on 8/20/04 at 23:00 (158491)

Pauline:

The fat that Dr. Chairman used was basically liposuctioned (to the best of my knowledge) so it did not constitute living tissue that would continue to hold up under the heal bone. The structure of fat under the heel bone is somewhat unique in that it is septated (sort of like bubble wrap) creating a living cushioning mechanism -- there have been papers written about it.

I have also heard of Sol Balkin's preliminary results that look good. I am not certain how the silicone does not migrate when subject to the stresses of walking. Commerical availablity of that product (my guess) is probably a while off.

I had used collagen injection although not on the heel. I actually found them to be reasonably successful although do not have long term follow up information. I am not sure why the collagen used for feet went off the market.
Ed

Re: why can't heel pad fat be replaced?

Julie on 8/21/04 at 01:59 (158493)

What causes the heel pad to break down? Is it a combination of age and use? I'm wondering about my own! I am nearly 70 and do a lot of walking on stony ground. I haven't noticed any problems so far, but - I'm wondering.
.

Re: why can't heel pad fat be replaced?

Dr.David Wander on 8/21/04 at 07:58 (158499)

Julie,

Basically it is a combination of factors including repititive stress, injuries, bone structure, the amount of fat that was originally present, prior injections and good old wear and tear. It's kind of like wearing out the treads on a tire!

Re: why can't heel pad fat be replaced?

Julie on 8/21/04 at 08:50 (158500)

Thank you, Dr Wander. That sounds like good news and bad news. My 'tires' have had only one injury, PF (if that counts as injury) and no injections. They've had plenty of wear and tear and repetitive stress, though, and I want them to take many more years of it, so I have to hope that a decent bone structure and fat content will see them through.
.

Re: why can't heel pad fat be replaced?

Ed Davis, DPM on 8/21/04 at 14:08 (158510)

Dr. W and Julie:
I like the tire analogy as it is valid except that humans, to an extent, regenerate tissue. Our bodies are in a state of flux, constantly breaking down and rebuilding tissue. If the breakdown process outstrips the build up, that is when problems occur. We have a very incomplete understanding of this area but speculate that hormonal influences are at work. We know, for example that a patient with giantism (an excess of groeth hormone that persists after closure of the growth plates) has an abnormally thick calcaneal (heel) fat pad and believe that that may give us some clues...
Ed

Re: why can't heel pad fat be replaced?

Dr.David Wander on 8/22/04 at 10:52 (158538)

Dr. Ed,

Although hormones certainly play a role, fat cells are determined at birth. As far as I'm aware fat cells do not rebuild/regenerate but do get larger or smaller.

Re: why can't heel pad fat be replaced?

Pauline on 8/22/04 at 17:56 (158547)

Here is an interesting look into the future use of fat cells.

http://www.millennium-debate.org/ind10april2.htm