Pilot Study: Fat Pad Restoration With Adipose Allograft in Metatarsalgia Patients Shows Structural, Functional Improvement.

Background: Metatarsalgia is a painful and debilitating condition that is often linked to plantar fat pad atrophy, particularly in active individuals and those with structural foot deformities. Current treatment options range from conservative measures-such as orthotics and padding, which often provide only temporary relief-to more invasive surgical corrections. Fat pad restoration has emerged as a promising nonsurgical solution. Human adipose tissue allograft (hATA) is a novel therapeutic option for reconstruction or supplementation of adipose defects or damage. Methods: This retrospective case series included 9 patients (10 feet) with metatarsalgia secondary to plantar fat pad atrophy who underwent in-office implantation with 1.5 mL of hATA between August and November 2024. All procedures were performed using an 18G blunt-tip cannula, with offloading protocols postinjection. Outcomes were assessed at 12 weeks using ultrasound-based measurements of fat pad thickness and Foot and Ankle Disability Index scores. Results: At 12 weeks, 9 of 10 treated feet showed increased fat pad thickness (mean gain 0.21 cm, 65% improvement). Foot and Ankle Disability Index scores improved in 8 of 9 patients, with a mean increase from 66.0 to 84.2 (18.1 points); 56% of patients exceeded the minimum clinically important difference of 10 points. No statistically significant correlation was observed between tissue thickness gain and functional improvement (Pearson Conclusions: Use of hATA seems to be a safe, nonsurgical option with potential to restore cushioning and reduce symptoms in patients with metatarsalgia.