Fat Grafting for Pedal Fat Pad Atrophy: A Narrative Review of the Literature.

Introduction: Pedal fat pad atrophy involves the loss of shock-absorbing adipose tissue beneath the foot, causing pain, reduced mobility, and risk of skin breakdown. Autologous fat grafting has gained attention as a regenerative approach that restores natural cushioning rather than merely masking symptoms.

Methods: PubMed, Web of Science, and Google Scholar were searched through 02/01/2025 for studies on autologous fat grafting for pedal fat pad atrophy of any etiology. Data regarding pain relief, functional outcomes, complications, and comparisons with orthotics, dermal fillers, silicone implants, and allograft adipose matrix were examined.

Results: Autologous fat grafting demonstrated substantial, sustained pain reduction and improved foot function in multiple studies. Randomized trials showed superior outcomes over conservative management, with decreased pain scores and enhanced mobility persisting up to two years post-procedure. Imaging assessments indicated stable or redistributed graft volume correlating with long-term symptom relief. Complications were minimal, typically limited to minor bruising or temporary discomfort. Comparisons revealed that while dermal fillers provide short-term cushioning and silicone implants pose regulatory concerns, allograft adipose matrix also exhibits regenerative effects similar to autologous fat grafting but without donor-site morbidity.

Conclusion: Autologous fat grafting effectively addresses pedal fat pad atrophy by restoring lost cushioning and alleviating pain. Its low complication rate, durable outcomes, and regenerative potential position it as a favorable therapeutic option. Longer-term studies comparing autologous to other approaches will refine patient selection, optimize foot pad restoration, and improve outcomes in these populations.

Level of evidence: 5: