Grants Funded

Abstract
The metatarsal fat pads are specialized compartments of fat that cushion the foot to reduce shear and torque. Fat pads can diminish in size due to age, obesity, diabetes, use of high-heel shoes, steroid use, or heavy use by athletes, leading to less shock absorption and increased pressure. Fat pad atrophy may result in significant pain or metatarsalgia, foot ulcers and calluses, ultimately leading to a loss in productivity, emotional pain, and financial loss. Several studies have shown that loss of plantar fat can result in increased foot pressures and decreased tissue thickness. Autologous fat grafting to areas of fat pad loss may reduce foot pressures, and thus alleviate symptoms. Plastic surgeons are aptly skilled in fat grafting with the potential to make a significant contribution. Current treatment modalities for fat pad atrophy include orthotics, padded shoes, as well as silicone injections and other temporary fillers; however, no objective studies using autologous fat have been performed. Approximately 30 adults, who experience pain from fat pad atrophy, will be recruited into a randomized, controlled, cross-over study; some patients will receive fat grafting, while some will receive standard of care podiatric treatment, then cross-over to fat grafting treatment after a year. Foot pressures and tissue thickness will be measured over two years. We hypothesize that fat grafting to areas of increased pedal pressure will reduce foot pressure during gait and increase soft tissue thickness, providing durable relief from pain. This pilot study will help build new collaborative efforts between Foot and Ankle Surgery, Podiatry and Plastic Surgery, combining expertise in foot biomechanics with reconstructive fat grafting, and will open the door to future studies.

Biography
Dr. Jeffrey Gusenoff is an Associate Professor of Plastic Surgery in the Department of Plastic Surgery at the University of Pittsburgh Medical Center. He is originally from Newton, Massachusetts and completed both his undergraduate and medical degrees at the Johns Hopkins University. He then completed his surgical internship and plastic surgical residency at the University of Rochester, in Rochester NY. After his formal training, Dr. Gusenoff elected to complete a fellowship in Post-Bariatric Body Contouring at the University of Pittsburgh, Pittsburgh PA. Dr. Gusenoff was the founder and Director of the University of Rochester Medical Center Life After Weight Loss Program from 2008-2012. The multidisciplinary program aimed to meet the body contouring needs of patients who have changed their lives through significant weight loss. He was the recruited by UPMC to join the Department of Plastic Surgery as Co-Director of the Life After Weight Loss Program with Dr. J. Peter Rubin. Dr. Gusenoff is also the Director of the Fellowship in Post-Bariatric Body Contouring Surgery and Director of Medical Student Education in Plastic Surgery at UPMC. Dr. Gusenoff has won numerous academic awards and written several peer-reviewed articles and book chapters, mostly related to body contouring surgical techniques, safety, and social issues. Dr. Gusenoff is also involved in several clinical research projects at the UPMC. He is very active in the community and is Co-Director of the BodyChangers program, which is a support group and lifestyle program to aid in weight loss maintenance.