From the Guidelines
Hyaluronic acid injections are a recommended treatment for forefoot fat pad atrophy, with high molecular weight hyaluronic acid being the preferred choice, as it may have a superior effect in pain reduction and functional improvement, as suggested by studies on its use in knee OA 1. The treatment approach typically involves a series of injections directly into the affected area of the forefoot. Key considerations for the treatment include:
- Using a high molecular weight hyaluronic acid preparation
- Administering 1-2 ml of hyaluronic acid (20-40 mg/ml) per foot
- Repeating the treatment every 4-6 weeks for a total of 3-4 treatments
- Performing the procedure under sterile conditions by a qualified podiatrist or orthopedic specialist Before treatment, the area should be cleaned and a local anesthetic may be applied to minimize discomfort. The injections are usually given using a small needle, distributing the hyaluronic acid evenly across the atrophied fat pad. Patients may experience mild discomfort or swelling after the procedure, which typically subsides within a few days. Hyaluronic acid works by providing immediate cushioning to the forefoot and may stimulate the body's natural production of collagen and elastin, potentially leading to long-term improvement. This treatment can help reduce pain, improve comfort while walking, and potentially slow the progression of fat pad atrophy, as part of a comprehensive treatment plan that may include wearing appropriate footwear, maintaining a healthy weight, and avoiding prolonged standing or walking on hard surfaces 1.
From the Research
Treatment for Forefoot Fat Pad Atrophy
The treatment for forefoot fat pad atrophy using hyaluronic acid (HA) is as follows:
- Hyaluronic acid injections have been used to manage metatarsalgia, a common overuse injury that may be caused by wearing high-heeled shoes 2.
- A 6-month, open study conducted in 15 subjects with metatarsalgia due to regularly wearing high-heeled shoes found that hyaluronic acid injections under the metatarsal heads provided a significant and long-lasting improvement in metatarsalgia 2.
- Another study found that ultrasound-guided hyaluronic acid injection was clinically effective for pain relief and functional improvement for at least 12 months in patients with Morton's neuroma, a common cause of forefoot pain 3.
- However, there is limited evidence on the use of hyaluronic acid specifically for the treatment of forefoot fat pad atrophy.
- Other treatments for forefoot fat pad atrophy include fat grafting, which has been shown to provide long-lasting improvements in pain and function, and prevent worsening from conservative management 4, 5.
- Allograft adipose matrix (AAM) has also been evaluated as a treatment for fat pad atrophy, with early clinical observations demonstrating that patients could resume daily activities after treatment 6.