title: Autologous Fat Grafting for Pedal Fat Pad Atrophy: A Prospective Randomized Clinical Trial.
abstract: 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. The authors 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, and group 2 underwent conservative management for 1 year.
  
  
  RESULTS
  Thirteen patients (two men and 11 women) constituted group 1 and 12 patients (four men and eight women) constituted group 2. Ten patients in group 1 underwent bilateral injections with a mean volume of 4.8 cc 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 third 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 < 0.05).
  
  
  CONCLUSIONS
  Pedal fat grafting significantly improves pain and disability outcomes, and prevents against worsening foot pressures. Future analysis will reveal whether fat grafting has lasting efficacy.
  
  
  METHODS
  Therapeutic, II.
authors.affiliation: Pittsburgh, Pa.|From the Department of Plastic Surgery, Division of General Internal Medicine, Department of Medicine, and Division of Foot and Ankle Surgery, Department of Orthopaedics, University of Pittsburgh Medical Center.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Gusenoff
authors.affiliation: Pittsburgh, Pa.|From the Department of Plastic Surgery, Division of General Internal Medicine, Department of Medicine, and Division of Foot and Ankle Surgery, Department of Orthopaedics, University of Pittsburgh Medical Center.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Mitchell
authors.affiliation: Pittsburgh, Pa.|From the Department of Plastic Surgery, Division of General Internal Medicine, Department of Medicine, and Division of Foot and Ankle Surgery, Department of Orthopaedics, University of Pittsburgh Medical Center.
authors.forename: Kwonho
authors.initials: K
authors.lastname: Jeong
authors.affiliation: Pittsburgh, Pa.|From the Department of Plastic Surgery, Division of General Internal Medicine, Department of Medicine, and Division of Foot and Ankle Surgery, Department of Orthopaedics, University of Pittsburgh Medical Center.
authors.forename: Dane K
authors.initials: DK
authors.lastname: Wukich
authors.affiliation: Pittsburgh, Pa.|From the Department of Plastic Surgery, Division of General Internal Medicine, Department of Medicine, and Division of Foot and Ankle Surgery, Department of Orthopaedics, University of Pittsburgh Medical Center.
authors.forename: Beth R
authors.initials: BR
authors.lastname: Gusenoff
mesh_terms: D000328:Adult; D000368:Aged; D001284:Atrophy; D005260:Female; D005500:Follow-Up Studies; D005545:Forefoot, Human / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011312:Pressure; D011446:Prospective Studies; D050151:Subcutaneous Fat / Q000473:pathology* / Q000637:transplantation*; D014182:Transplantation, Autologous; D016896:Treatment Outcome