From the Research
The most effective treatment for forefoot fat pad atrophy (FFPA) is autologous fat grafting, as it provides long-lasting improvements in pain and function, and prevents against worsening from conservative management 1.
Treatment Options
The treatment for FFPA typically involves a combination of conservative measures and, in some cases, surgical intervention. Initially, focus on conservative treatments such as:
- Wearing cushioned shoes with metatarsal pads or custom orthotic insoles to redistribute pressure away from the affected area
- Avoiding high heels and shoes with thin soles For more advanced cases, injectable fillers like hyaluronic acid or autologous fat grafting can be considered. These procedures involve injecting material into the atrophied area to restore cushioning.
Autologous Fat Grafting
Autologous fat grafting has been shown to be effective in improving pain and functional impairment from forefoot fat pad atrophy 1, 2. The procedure involves injecting fat into the atrophied area to restore cushioning.
Patient Selection
Patient demographics and foot characteristics may play a role in the level of impact that is achieved following surgery 3. However, all patients with suspected pedal fat pad atrophy should be considered for soft tissue augmentation.
Additional Considerations
Additionally, patients should be advised to:
- Maintain a healthy weight
- Avoid activities that put excessive stress on the forefoot The goal of treatment is to alleviate pain, improve function, and prevent further deterioration of the fat pad. The underlying principle is to reduce pressure on the atrophied area while providing additional cushioning, either through external means (orthotics) or by restoring the fat pad itself (injections or surgery).
Recent Developments
Recent studies have also explored the use of allograft adipose matrix (AAM) for foot fat pad restoration, which has shown promising results in improving patient outcomes 4. However, more research is needed to fully understand the effectiveness of this treatment option.
Recommendation
Based on the most recent and highest quality study, autologous fat grafting is the recommended treatment for forefoot fat pad atrophy, as it provides long-lasting improvements in pain and function, and prevents against worsening from conservative management 1.