Sharman Johnson — Fat Pad Atrophy

The Challenge: Fat Pad Atrophy

Sharman Johnson is a dentist practicing in Washington, D.C. who leads an active lifestyle. Recently, she spent time in Maine’s Acadia National Park, negotiating nature trails and biking on old carriage roads through the trees.

But for a long time, Sharman dealt with extreme foot pain that made exercise difficult, if not impossible. The pain started in 2008 as she trained for long-distance running. The ball of her left foot hurt. She also noticed a strange sensation in the metatarsal area of both feet, as if they had developed extra padding.

“It was like walking on an air bubble,” she recalls.

Sharman went to a local podiatrist who determined that she had Morton’s Neuroma, which occurs when the outer coating of a nerve in the foot thickens and causes discomfort or pain. He injected Sharman with cortisone in both feet, which left her in excruciating pain. Later, Sharman learned that she had been misdiagnosed. Her actual condition was peripheral neuropathy, or damage to the nerves that often causes numbness and pain.

Sharman could barely walk because the cortisone shots had caused foot fat pad atrophy, which occurs when fat dissipates from the protective cushion surrounding the bones of the foot. During that year, she saw six other podiatrists to find relief. No one could help her.

For 10 years, Sharman managed the pain in her feet, which recovered to some degree over time. She wore supportive footwear and eased back into activities like walking and running, but at shorter distances. Still, the pain persisted – she just learned to live with it.

In 2018, Sharman reached a turning point. After spending an active day in sandals, she realized she’d done too much. Her left foot hurt so badly, she didn’t think it would recover. Another visit to a local podiatric specialist left her without any relief.

The Path To UPMC: Online Research

Out of options locally, Sharman searched online for help, which is how she came across Jeffrey Gusenoff, MD, a UPMC plastic surgeon, and Beth Gusenoff, DPM, a podiatrist and assistant professor at the University of Pittsburgh. Together, the husband and wife team had developed a novel procedure involving fat grafting to the feet to treat patients with pedal fat pad atrophy. Having completed successful clinical trials, the doctors were now offering foot fat grafting as an elective procedure.

Sharman decided to email the doctors to see if she was a candidate for the new procedure. “They were very thorough and hands-on. I spoke to Dr. Jeff first,” Sharman says. “He phoned me, which I thought was incredible.”

The Solution: Foot Fat Grafting

Once in Pittsburgh, Sharman underwent foot fat grafting to address her fat pad atrophy. In this procedure, fat cells are harvested through liposuction from one’s abdomen or thighs. Once processed, the fat cells are injected into the affected area of the foot to increase its cushion and minimize pain on impact.

Sharman felt reassured by the doctors’ professionalism and care. Though recovery was a long and sometimes painful road, she appreciated the follow-up provided by the doctors. Dr. Beth Gusenoff was in frequent contact via email, asking how Sharman was doing.

The Results: Back to Biking and Walking

Five months after the procedure, Sharman is enjoying physical activity again. Though she doesn’t plan on returning to running, she’s back to biking and walking up to three miles a day.

She sees a trainer twice a week and fully enjoyed her recent trip to Acadia National Park. She hopes to return to western Pennsylvania soon to visit Frank Lloyd Wright’s Fallingwater. On her way, she’ll stop in to see the Gusenoffs.

“I’m so grateful, I would like to thank them again in person,” she says.