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 r = −0.38). Conclusions: Use of hATA seems to be a safe, nonsurgical option with potential to restore cushioning and reduce symptoms in patients with metatarsalgia.
Jodi Schoenhaus Gold (Mon,) studied this question.