Clinical Cases Demonstrating Fat Pad Restoration Using a Novel Adipose Allograft Matrix*

Fat pad atrophy is the loss of adipose tissue and cushioning function. There is additional strain and pressure generated which leads to inflammation and micro-injury in the foot, causing pain and discomfort to the patient. Some causes of fat pad atrophy include aging, trauma, rheumatoid arthritis, and diabetic neuropathy.1 A novel adipose allograft matrix (AAM) can help support fat pad restoration through host fat remodeling and neovascularization.2 This study presents two cases treated with AAM resulting in reduced pain and improved lifestyle for the patients. Case 1 was an 80 year old female with type II diabetes and rheumatoid arthritis. She had fat pad atrophy below the metatarsal heads of the right foot and was in pain upon weight bearing. Shoes and orthotic devices were unsuccessful. AAM was injected in the plantar aspect of her foot to help build up the fat pad. Off-loading bandages were applied to her foot post-injection. After four months, the plantar aspect of the foot was not painful and she was able to perform her routine activities without limitations. Case 2 was an 80 year old male with peripheral neuropathy and recurring heel ulcer secondary to fat pad loss of the plantar heel. Wound closure was achieved through debridement and offloading, but the wound re-ulcerated due to underlying fat pad atrophy and bony protuberance. To rebuild the fat pad and reduce the likelihood of reoccurrence, AAM was injected into the atrophied tissue area after wound closure and off-loaded with a pad. At six months, it was stable and additional AAM was injected to help avoid surgical bony debridement in the future. These cases demonstrate the role of AAM in assisting with fat pad restoration of adipose tissue to support cushioning, which results in decreased pain and improved quality of life.