Updated: Aug 13, 2018
High-heeled shoes have been around for centuries and even though the average height of heels worn has changed throughout the years, one thing remains the same: They continue to be worn by many women on a daily basis, whether for social occasions or work. It is not always a pain-free venture, though, to wear 3+ inch heels for several hours a day. Added pressure gets placed on the smaller bones in the forefoot, which can cause painful conditions such as metatarsalgia (pain and inflammation of the metatarsal heads), and neuromas (pinched nerve in the forefoot).
This is where Sculptra® Aesthetic, and other dermal foot fillers, can play a role. The same injections used in the face can also be injected into the foot. The filler will not cure all foot pains and problems that result from the use of high heels, but it can help replace the lost cushion underneath the ball of your foot and heel.
Fat Pad Atrophy
Foot fat pad atrophy refers to the loss and thinning of the fatty cushion underneath the balls of the feet and heels. This thinning is often a result of age and increased mileage placed on the feet, but repeated steroid injections in the forefoot can also cause atrophy. When this happens, the underlying bony areas (e.g. metatarsal heads, heel bone) are more prominent so when you walk barefoot, on hardwood floors, or are wearing high heeled shoes, these areas can become painful.
Sculptra® is a synthetic (poly-L-lactic acid), biodegradable, injectable filler that is commonly used in the face, but as an off-label use it can also be injected in the feet for the treatment of fat pad atrophy. It is easily injected into the ball of the foot or the heel, thus re-creating the once lost cushion underneath the foot, allowing you to go back into those high heels.
What Is the Injection Process?
It is important to meet with the doctor for an initial consultation visit prior to having the Sculptra procedure. A thorough history and physical exam should be performed to confirm the diagnosis, learn what treatment options have already been tried, and to discuss the Sculptra procedure, risks, and potential complications. Furthermore, Sculptra is not indicated for everyone and some medications may need to be stopped before the procedure, so it is essential to go over your medication list prior to receiving the injections. It is important to be well-informed and prepared for the procedure beforehand to help minimize the risk of potential complications.
The procedure can be done in-office. A local anesthetic block is performed to numb the affected area. The pre-mixed Sculptra solution is then injected into and/or around the atrophied area. After the procedure, an ice pack will be placed on your foot to help minimize swelling and inflammation.
Post-Procedure (*these are generalized instructions)
Mild swelling and discomfort are common and OK, but should decrease within 48-72 hours.
Icing can help reduce swelling and bruising.
It is important to massage the area for multiple days after the procedure.
Avoid alcohol for 24 hours and anti-inflammatory medications for 48 hours after the procedure. Tylenol is OK for pain or swelling.
Avoid the sun and UV light until redness and swelling resolve. If you do go out into the sun, it is recommended that you protect the areas with sunscreen (SPF 30-45 or greater)
Possible Adverse Effects (Things to watch out for)
Pain & discomfort – Usually mild but should improve within days. Monitor for increasing redness and swelling that does not improve, or continues to worsen, after 3 days. If signs/symptoms worsen, contact the doctor.
Bruising – If this happens, it is usually minimal and will typically resolve within a week.
Granuloma – This is rare, but you may form a tiny nodule around the areas of the injection sites. It can resolve on its own with time, but a local steroid injection can also be performed in the clinic.
How long will the injections last?
Around 4 weeks after your first injection treatment session, you will be reassessed, and a second treatment session may be necessary. Once the area is deemed satisfactory, the filler may last several months up to a year, or longer. There are a number of factors that will determine how long the filler lasts, including how much was used, the shoes you wear, how much you walk, and your participation in higher impact activities. Because the material is biodegradable, the need for future repeat injections is likely.
The above information is meant for educational purposes only and should not be construed as medical advice. The instructions above are generalized and used by Dr. Falk for her patients. They are often customized based on her patients' needs, and they are not intended for use by the general public. Please consult the doctor, or your own healthcare professional, if you have questions or concerns related to your own health, or if you are interested in Sculptra® Aesthetic.