On today’s episode we’re joined by Drs. Beth + Jeff Gusenoff to discuss their expertise in fat grafting as a remedy for heel pain.

Show Notes

Beth Gusenoff, D.P.M., FACFAS

Clinical Assistant Professor of Plastic Surgery Department of Plastic Surgery
University of Pittsburgh Medical Center, Pittsburgh, PA

Jeffrey Gusenoff, M.D.

Professor of Plastic Surgery, Clinical and Translational Science Department of Plastic Surgery
Director, Foot Fat Grafting Program
Co-Director, Life After Weight Loss Program Co-Director, BodyChangers
Director, Fellowship in Post-Bariatric Body Contouring Director, Medical Student Rotation in Plastic Surgery

02:20 How they got onto the path of fat pad supplementation

The University of Pittsburgh, which is a mecca for adipose stem cell biology.

04:14 Complexity of Plantar Heel Pain and development of clinical trials

Micro and macro chambers in the inferior calcaneal fat pad.

06:09 Shock absorption characteristics of the inferior calcaneal fat pad.

07:50 Steroid effects on the inferior calcaneal fat pad.

09:51 Fat pad atrophy in the High BMI patient

10:00 Nack and Phillips article

10:13 Biomechanical disruption of the inferior calcaneal fat pad.

11:19 The Heel in the Cavus Foot

11:38  Multiple etiology heel pain

15:25 The “Wrinkle” Test

16:18 Sonographic Criteria for Fat Pad Atrophy

There’s really no established ultrasound imaging criteria at this point for fat pad atrophy.

18:12 Findings in Different Foot Types

18:39 Equinus?

19:43 Processing the fat.

20:00 Donor Site and Technique of Fat Pad supplementation in the Human Heel.

21:05 The Coleman Method

We currently use a Coleman method, which is a pretty standard method of centrifuging the fat so we collect a bunch of tubes, spin it down in a centrifuge that separates it into the three layers, then we separate out the oil and the aqueous part of the bottom, which leaves us with the good fat in the middle. And then we transfer that into the foot.

24:12 Biomechanics of the Fat Pad after Fat Grafting

25:00 Physiology of the Fat Pad after Fat Grafting

27:47 The Golf Ball in the Mayo Jar

29:23 Post-operative Management

31:46 Fat Pad Atrophy after Steroid Injections

33:12 The “Skin on Bone” Cases

40:00 Fat Pad Grafting in the Forefoot

40:52 Fat Pad Grafting for Failed Neurectomies

43:38 Temporary Effect

44:14 Amount of Fat Supplemented

44:41 Cross-Hatch Technique

46:05 Leneva and Other Fillers versus Autologous Supplementation

47:21 Preliminary Trials at University of Pittsburgh

50:00 Research in Scaffolds

51:09 The PopSole

52:44 Clinical Trials with the PopSole

55:03 Utility of the PopSole

58:19 How to Contact Drs. Beth and Jeffrey Gusenoff

gusenoffbr@upmc.edu                                                                                         jgusenoff@gmail.com

58:52 Liquid Gold

59:10 Does it Matter Where You Take the Fat From?