Long-Term Outcomes of Autologous Fat Grafting for Pedal Fat Pad Atrophy

Forefoot and heel fat pad atrophy are debilitating conditions that compromise structural integrity of the plantar soft tissues, resulting in pain and disability. This localized destruction of soft tissue integrity has been associated with increased age, diabetes, and repetitive trauma. Although autologous fat grafting has shown improvements to short-term patient pain levels and quality of life, there is limited evidence as to the long-term benefit of this treatment.

This study aims to evaluate the long-term outcomes of autologous fat grafting to the foot for fat pad atrophy treatment.

This was a cross-sectional long-term follow-up of patients who underwent autologous fat grafting for pedal fat pad atrophy between 2015 and 2018. Patients received grafting at presentation (interventional cohort) or after 1 year of conservative management (crossover cohort). Demographic and procedural data were collected. Patient-reported outcomes were assessed using the Manchester Foot and Disability Index (MFDI) at baseline, final in-office follow-up, and long-term follow-up (mean: 9 y). After correction of raw data outliers, statistical analyses included Fisher exact and Wilcoxon rank-sum for baseline associations, Mann-Whitney U tests for long-term between-group comparisons, and repeated-measures ANOVA for within-group changes in forefoot patients only. Heel outcomes were reported descriptively due to small sample size.

Of 36 eligible patients, 25 participated (69.4% response rate; mean follow-up 9.0±1.2 y). Interventional (n=14) and crossover (n=11) cohorts showed no significant long-term differences across all domains (pain, function, appearance, work/leisure). Forefoot grafting significantly improved appearance (mean change: -2.9 to 0.8, P <0.001) but demonstrated functional decline at long-term follow-up (mean: 12.9 to 7.2, P =0.020). Heel grafting was associated with durable functional improvement (median difference, P =0.004) and trended towards pain reduction, although appearance outcomes were lower compared with forefoot patients ( P =0.002). Work/leisure outcomes showed no significant long-term differences ( P =0.087).

Autologous foot grafting confers durable, site-specific benefits nearly a decade post-procedure. Heel grafting restores long-term function, whereas forefoot grafting primarily improves cosmesis. Importantly, timing of grafting (immediate vs. delayed) does not alter durability, underscoring the need for location-specific treatment counseling and potential repeat procedures in forefoot patients.