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Fat Grafting for Pedal Fat Pad Atrophy in a 2-Year, Prospective, Randomized, Crossover, Single-Center Clinical Trial

Minteer, Danielle M. Ph.D.; Gusenoff, Beth R. D.P.M.; Gusenoff, Jeffrey A. M.D.

Plastic and Reconstructive Surgery: December 2018 - Volume 142 - Issue 6 - p 862e-871e
doi: 10.1097/PRS.0000000000005006

Background: By age 60, 30 percent of Americans suffer from fat pad atrophy of the foot. Forefoot fat pad atrophy results from long-term aggressive activity, genetically dictated foot type, multiple forefoot steroid injections, surgery, and foot trauma.

Methods: The authors present data from a 2-year, prospective, randomized crossover study performed to assess pain and disability indexes, fat pad thickness, forces, and pressures of stance and gait. Group 1 underwent fat grafting with 2 years of follow-up, and group 2 underwent conservative management for 1 year, then underwent fat grafting with 1 year of follow-up.

Results: Eighteen subjects (14 women and four men) constituted group 1. Thirteen subjects (nine women and four men) constituted group 2. Group 1 reported the worst pain at baseline and group 2 experienced the worst pain at 6- and 12-month standard-of-care visits; pain for both groups improved immediately following fat grafting and lasted through study follow-up (p < 0.05). Group 1 demonstrated functional improvements at 12, 18, and 24 months postoperatively (p < 0.05), whereas group 2 demonstrated the highest function at 12 months postoperatively (p < 0.05). Pedal fat pad thickness of subjects in group 1 increased postoperatively and returned to baseline thickness at 2 months postoperatively; subjects in group 2 experienced return to baseline thickness at 6 months postoperatively (p < 0.01). Forces and pressures of stance and gait increased over the 2 years of follow-up for group 1 (p < 0.05).

Conclusion: Pedal fat grafting provides long-lasting improvements in pain and function, and prevents against worsening from conservative management.


Pittsburgh, Pa.

From the Department of Plastic Surgery, University of Pittsburgh.

Received for publication November 22, 2017; accepted May 1, 2018.

This trial is registered under the name “Fat Grafting for Pedal Fad Pad Atrophy,” identification number NCT01796808 (

Presented at Plastic Surgery The Meeting 2017, Annual Meeting of the American Society of Plastic Surgeons, in Orlando, Florida, October 6 through 10, 2017; the 60th Ohio Valley Society of Plastic Surgeons Meeting, in Pittsburgh, Pennsylvania, June 2 through 4, 2017; and the 63rd Annual Scientific Meeting of the Robert H. Ivy Society, in Philadelphia, Pennsylvania, April 22, 2017.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

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This work was supported by THE PLASTIC SURGERY FOUNDATION.

Jeffrey A. Gusenoff, M.D., 3380 Boulevard of the Allies, Suite 138, Pittsburgh, Pa. 15213,

Copyright © 2018 by the American Society of Plastic Surgeons