A new clinical trial from the University of Pittsburgh Medical Center has found that fat grafting—a minimally invasive procedure that uses your own fat—can significantly reduce pain and improve function for people suffering from foot fat pad atrophy.

What Is Pedal Fat Pad Atrophy?

Your feet have specialized fat pads under the balls and heels to absorb shock and protect bones from pressure.

Pedal fat pad atrophy involves the loss or thinning of this fatty cushion located beneath the metatarsal heads—the bones at the base of the toes.

The pedal fat pad serves as a shock absorber during movement, and when it diminishes patients can experience significant pain, especially when walking barefoot or standing for long periods. Over time—or after surgery, steroid injections, or injury—these fat pads can wear down, a condition called plantar fat pad atrophy. Without that natural cushioning, each step can cause sharp pain, making walking, standing, and even enjoying hobbies difficult.

Common causes include [Minteer et al, 2018; Basadonna et al, 1999; Bowling et al, 2010]:

• Aging (affecting approximately 30% of adults over 60)

• Repetitive stress or high-impact activity

• Obesity

• Steroid injections

• Prior foot surgeries

• Anatomical foot types or deformities

• Certain medical conditions (e.g., diabetes, collagen vascular diseases)

Conventional treatments typically rely on external devices like orthotics or silicone fillers. Unfortunately, these are temporary solutions, often fail to address the underlying issue, and suffer from poor long-term patient compliance.

Why Fat Grafting May Be a Game-Changer

Conventional treatments—like shoe inserts, pads, or custom orthotics—offer only temporary relief and can be bulky or uncomfortable.

Fat grafting takes a different approach:

• A small amount of fat is gently removed from your abdomen or flanks.

• The fat is purified and injected into the areas of your foot where cushioning has been lost.

• This restores a natural padding layer that moves with your foot and absorbs impact.

The Study: Fat Grafting vs. Standard Care

Researchers followed 25 patients with painful foot fat pad atrophy for one year (Gusenoff et al, 2016).

• Group 1 received fat grafting right away.

• Group 2 continued with conservative care, like orthotics.

Key findings after 12 months:

• Pain: Patients who had fat grafting reported less pain than the control group (p = 0.019).

• Function: Significant improvement in walking and daily activities (p = 0.039).

• Work & Leisure: Patients returned to hobbies and work activities more comfortably (p = 0.002).

• Protection Against Worsening: Foot pressures and forces stayed stable in the fat grafting group, but got worse in the control group.

Does the Fat Last?

Interestingly, ultrasound scans showed that while some of the fat cushion thinned over time, patients still felt better.
Researchers believe the injected fat may redistribute around the bone, continuing to protect sensitive areas and relieve pain—even if thickness measurements drop.

Is Fat Grafting Right for You?

You might be a candidate if you have:

• Pain in the ball of your foot that feels like you’re walking on pebbles or bone

• History of neuroma surgery or multiple steroid injections

• High-arched feet or other structural issues

• Limited relief from orthotics or shoe pads

What to Expect From the Procedure

• In-office setting with local anesthesia

• Small incisions for fat removal and injection

• Walking allowed right after surgery (with cushioned shoes)

• Light activity for 4–6 weeks—no barefoot walking during this time

• Most patients notice improvement in pain within months

Real Patient Impact

Patients in the trial described finally being able to walk without wincing, getting back to exercise, and enjoying activities they had put aside for years.

Bottom Line

This study shows that fat grafting is a safe, minimally invasive treatment that can provide lasting pain relief for people with foot fat pad atrophy.

While more research is needed to see how long the results last beyond a year, the findings are promising—especially for those who have tried everything else without relief.

💬 Thinking about fat grafting for foot pain? Schedule a consultation:

(781) 591-7855

info@BSBortho.com

20 Walnut St

Suite 14

Wellesley MA 02481

References:

Basadonna PT, Rucco V, Gasparini D, Onorato A. Plantar fat pad atrophy after corticosteroid injection for an interdigital neuroma: a case report. Am J Phys Med Rehabil. 1999 May-Jun;78(3):283-5.

Bowling FL, Metcalfe SA, Wu S, Boulton AJ, Armstrong DG. Liquid silicone to mitigate plantar pedal pressure: a literature review. J Diabetes Sci Technol. 2010 Jul 1;4(4):846-52.

Gusenoff JA, Mitchell RT, Jeong K, Wukich DK, Gusenoff BR. Autologous Fat Grafting for Pedal Fat Pad Atrophy: A Prospective Randomized Clinical Trial. Plast Reconstr Surg. 2016 Nov;138(5):1099-1108. doi: 10.1097/PRS.0000000000002667. PMID: 27391833.

Minteer DM, Gusenoff BR, Gusenoff JA. Fat Grafting for Pedal Fat Pad Atrophy in a 2-Year, Prospective, Randomized, Crossover, Single-Center Clinical Trial. Plast Reconstr Surg. 2018 Dec;142(6):862e-871e.