Autologous Fat Grafting for Pedal Fat Pad Atrophy: A Prospective Randomized Clinical Trial.

Background: Pedal fat pad atrophy is associated with pain, decreased tissue thickness, and increased foot pressures. To date, no objective studies investigating the use of fat grafting to the forefoot have been performed. We hypothesize that pedal fat grafting can reduce pain, increase tissue thickness, and decrease pedal pressures. Methods: A prospective, randomized study was performed to assess tissue thickness, pain and foot pressures. Group 1 underwent fat grafting immediately with 1 year follow-up, while Group 2 underwent conservative management for 1 year. Results: 13 patients (2 male, 11 female) comprised Group 1 and 12 patients (4 male, 8 female) comprised Group 2. 10 patients in Group 1 underwent bilateral injections with a mean volume of 4.8cc per foot. Mean follow-up time was 11.1+/-5.4 months for Group 1 and 13.8+/-4.2 months for Group 2. At 1 year, Group 1 demonstrated improved foot function (p=0.022), pain (p=0.022), and work/leisure activities (p=0.021). Group 1 had no change in tissue thickness, whereas in Group 2, the right 3rd metatarsal tissue thickness decreased significantly (p=0.036). Foot pressures in Group 1 did not improve; however, Group 2 had a significant increase in left foot pressure (P=0.011). When comparing the groups at 1 year, Group 2 had significantly higher foot pressures and forces than Group 1 (p

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