How to Treat Painful Fat Pad Atrophy in The Foot (2022)

(Testimonial for Sole-Fill; resolved pain to ball of foot pain, 30 y/o Female)

Atrophy of the fat pad on the plantar aspect of the foot is a common condition that affects the heel or the forefoot, often referred to as the “ball” of the foot.

Over the past few years, the treatment modalities for fat pad atrophy have been gaining momentum in the field of foot and ankle surgery.

When you are walking, a pressure that equals more than 2.5 times your body weight can apply to your heel and front of your foot. Consequently, the fat pads, which are necessary to cushion these areas, may undergo atrophy and degenerate. Heel pain and pain to the front of your foot can be mistaken for plantar fasciitis in the heel or neuroma pain in the ball of your foot.

Wearing high heel shoes, standing on hard surfaces for long periods of time and certain activities like squats and lunges can put excessive mechanical stress and pressure on the balls of your feet which can contribute to plantar fat pad atrophy. Another common term used to describe plantar fat pad atrophy in the front of your foot is metatarsalgia. Getting older and certain diseases can also increase the likelihood of fat pad atrophy.

The Foot and Ankle Surgeons at Foot HealthCare Associates know how to treat painful fat pad atrophy in the foot. They have helped develop and refine techniques to augment and create new fat pads and cushioning, for those suffering with the pain of plantar fat pad atrophy. One of the non-invasive treatments developed at Foot HealthCare Associates is called “Sole-Fill™”.

In this article, we will briefly discuss the role of the fat pads in your foot, symptoms of fat pad atrophy, as well as the available treatment options for this condition.

What is the fat pad?

The fat pad is a thick collection of connective tissue that runs underneath the ball of the foot and the heel.

The purpose of the pad includes:

  • Providing a cushioning system to minimize the effect of pressure, friction, and gravitational forces on the food.
  • Serving as a mechanical anchor to shift the body weight without overwhelming connective tissues.

What is Fat Pad Atrophy?

Fat pad atrophy refers to the gradual loss of the fat pad in the ball or heel of the foot.

This condition is characterized by the thinning of the pad, which exposes the sensitive connective tissues to strain and pressure. As a result, inflammation and micro-tears occur.

(Video) Calcaneal fat pad atrophy-What is it and what does it look like?

Patients often report severe symptoms of pain and discomfort.

Other symptoms of fat pad atrophy include:

  • Pain in the foot that becomes worse after wearing high heels or walking on a hard, flat surface.
  • Painful sensations after spending long hours standing.
  • Sensing the development of edema in your foot or heel.
  • Callus formation in the ball of the foot makes it feel thicker.

Who is at risk of getting Fat Pad Atrophy?

The risk of developing fat pad atrophy is relatively similar between the two genders.

With that said, some experts suggest that females are more susceptible to developing fat pad atrophy due to:

  • Wearing high heels
  • Ill-fitting tight footgear

The following factors also increase the risk of fat pad atrophy:

Age: fat pad atrophy belongs to a large spectrum of diseases known as degenerative foot conditions. As you age, the production of new cartilage and fat tissues slows down, which makes the bones weaker and prone to injury.

Footwear: as mentioned above, wearing tight-fitting shoes might increase the risk of footpad atrophy. In the best-case scenario, this habit will deteriorate an already existing condition.

Injury: injuries endured after an accident are common triggers for fat pad atrophy, especially if several surgeries are performed in the foot area.

Family history: having a family history of fat pad atrophy seems to play an important role in developing this condition.

Arthritis: the active inflammation of the joints exacerbates fat pad condition and increases the risk of their atrophy.

(Video) Heel Pad Syndrome & Fat Pad Atrophy [BOTTOM of the Foot Pain FIX!]

Diabetes: chronically elevated blood pressure increases the risk of peripheral neuropathy – a condition that precipitates pressure-induced atrophy of the fat pad.

Medications: the chronic use of corticosteroids may induce the atrophy of fat pad in adults.

The treatment modalities for fat pad atrophy

Conservative treatment

The mainstays of treatment for heel fat pad atrophy are custom molded foot orthoses with padding, shoes that provide padding and support for the feet while walking, and heel cups or cushioned socks that help reduce the impact of walking on the foot, experts say.

“Conservative treatment can be quite successful; it can ease pain and prevent symptoms from getting worse. The idea is to replace the fat pad with shock absorption from the outside of the foot. As a result, pressure on the foot—especially on the bones and skin, where there is often damage that seriously impacts health—can be relieved,” said John Steinberg, DPM, chief of podiatric surgery at Medstar Georgetown Hospital in Washington, DC. “Unfortunately, we often get pushback from patients who don’t want to be burdened with wearing an orthotic that they must transfer from shoe to shoe, or to have to wear a shoe that looks orthopedic.”

Thus, it is vital to educate patients about the importance of wearing foot orthoses throughout the day and the best ways to choose proper footwear that is sturdy and cushioned, Steinberg said.

Patients with heel fat pad atrophy often do well with viscoelastic orthotic devices, heel cushions, and heel cups—and any material that has at least 3 to 5 mm of cushion, Kor said. Orthoses should also have a cushioned topcover, such as those made of closed-cell polyethylene foam.

“You want a covering that is cushioned, but also does not break down over a short period of time,” Kor said.

In addition to these conservative treatments, interventions that involve injecting materials into the foot have been tried—with varying degrees of success. One technique is to inject silicone into the foot, but this technique is controversial, since the silicone can migrate over time.8,9 Complications from injecting a foreign substance in the foot are also possible, Hanna said.

Another method used by some clinicians is to inject dermal fillers into the foot, a procedure similar to those in which fillers are injected in the face to address wrinkles. These materials include products made with poly-L-lactic acid and hyaluronic acid, but they are not Food and Drug Administration-approved for use in the foot, and research into their efficacy for heel fat pad atrophy has been limited, Hanna said.

(Video) Common Foot Conditions: Fat Pad Atrophy

(Testimonial for Sole-Fill; resolved pain to ball of foot pain, 60 y/o Female )

Fat grafting

One of the newest methods for how to treat painful fat pad atrophy is autologous fat grafting, or lipofilling, in which fat from other anatomical sites is injected into the bottom of the foot. Autologous fat grafting for the foot has been used since the 1990s, but early scientific studies on this technique were dogged with problems, especially necrosis of the fat. Recent research, however, has documented the effectiveness of autologous fat grafting for both pedal and heel fat pad atrophy.

In one study published in The Foot in 2014, a team of Italian researchers injected fat harvested from the abdomen in four patients during two sequential injections performed over 12 weeks.10 The four patients in the study had previously undergone repair of post-traumatic soft tissue loss of the foot with skin grafts and, in one case, a cross-leg fascio-cutaneous flap. All of the patients had pain in the plantar aspect of the foot after their surgeries, had difficulty bearing weight on the heel, and showed skin instability with recurrent ulcerations and callus formation. The heel fat pad injections were aimed at thickening the tissue at the plantar sole and increasing the weightbearing capability of the foot.

All four patients demonstrated restoration of the fat pad tissue and the functional structure of the sole of the foot after the lipofilling procedure, according to lead author Giovanni Nicoletti, MD, a plastic and reconstructive surgeon in the department of clinical, surgical, diagnostic, and pediatric sciences at the University of Pavia in Italy.

During recovery, the patients were advised to avoid dynamic and static plantar weightbearing for two weeks. Then, 30% partial dynamic and static plantar weightbearing was allowed, using crutches and soft socks, for two weeks. In the final two weeks of recovery, the patients could engage in full dynamic and static plantar weightbearing, wearing custom plantar insoles, custom shoes, or both.

All four patients experienced good outcomes from the surgery with no serious complications. However, clinicians should be aware of the risk of potentially serious complications associated with these procedures, including infection and fat necrosis from failed adipose tissue engraftment,10 Nicoletti said.

Fat grafting has also been tried as a means of preventing reulceration in high-risk diabetic feet. In a case report published in Plastic and Reconstructive Surgery Global Open,11 David Armstrong, DPM, MD, PhD, and colleagues used fat augmentation to address plantar fat pad atrophy and recalcitrant preulcerative lesions in a patient aged 37 years with type 2 diabetes who had previously undergone tibialis anterior tendon transfer for a progressive chronic styloid ulcer. After four weeks in a splint, the patient successfully transitioned to normal shoe gear, and had no complications or recurrence of his wound at six weeks, Armstrong says.

“The question we asked was: Will this type of grafting hold up? It appears it will, although we don’t have good long-term data yet,” said Armstrong, a professor of surgery at the University of Arizona and deputy director of the Arizona Center for Accelerated Biomedical Innovation in Tucson. “By using the technique of fat grafting for heel fat pad atrophy, we give our patients with diabetes time to recover from ulcers, reduce stress on the feet, and decrease the risk of ulcers. We can heal many of our diabetic patients with ulcers by using other techniques, but the real tough nut to crack is keeping these patients healed and giving them quality of life.”

As well as being a reconstructive surgery, the procedure was a means to achieve tissue repair, he said.

“Thus, we could interrupt the cycle of reulceration in the diabetic foot and keep patients with diabetes and diabetic neuropathy in remission [ulcer-free],” Armstrong said.

(Video) Fat pad atrophy and pain

If you suffer from the pain of fat pad atrophy and you live in or around the following areas, you can book an appointment with a doctor at Michigan Podiatry by clicking on this link:

Request an Appointment

  • Livonia, Michigan.
  • Novi, Michigan.
  • Southfield, Michigan.
  • Howell, Michigan.

Takeaway message

Footpad atrophy is a common condition that affects the ball and heel of the foot. The prompt treatment of this condition by one of the treatments listed can often provide dramatic relief and improve your quality of life.

The Doctors at Foot Healthcare Associates know how to treat painful fat pad atrophy. If you want to learn more, check out this link.

Sole-Fill

Sole-Fill Testimonial: Resolved Ball of Foot Pain 70y/o Male

(Video) Taping for painful heel fat pad | Melbourne Sports Chiropractor & Physiotherapist

FAQs

How do you treat foot fat atrophy? ›

Conservative treatment methods include:
  1. Rest. Stay off your feet as much as possible and limit high-impact activities that cause heel pain.
  2. Apply ice. ...
  3. Take medication. ...
  4. Wear orthopedic footwear. ...
  5. Taping your heel. ...
  6. Use heel cups, shoe inserts and cushioned socks. ...
  7. Exercise program.
14 Jun 2022

Why does the fat pad of my foot hurt? ›

Heel fat pad syndrome is a condition that happens as a result of changes in the elasticity and/or the thickness of the heel fat pad, this is often caused by wear and tear over time of the fatty tissues that make up the heel pads on our feet causing pain that could impact our daily routine and interfere with our regular ...

How long does fat pad syndrome take to heal? ›

What's the recovery prognosis for Fat Pad Syndrome/Impingement? * Generally, the prognosis is good. Most patients recover with conservative management in rehabilitation in 8 to 12 weeks. * Steroid injections can be recommended in cases of severe pain.

How do you tape a fat pad atrophy? ›

Try to stretch the outside edge of the tape more than the inner edge of the tape as this will help

How do I rebuild my fat pads on my feet? ›

Conservative treatment

The mainstays of treatment for heel fat pad atrophy are custom molded foot orthoses with padding, shoes that provide padding and support for the feet while walking, and heel cups or cushioned socks that help reduce the impact of walking on the foot, experts say.

What helps foot pad pain? ›

Lifestyle and home remedies
  1. Rest. Protect your foot from further injury by not stressing it. ...
  2. Ice the affected area. Apply ice packs to the affected area for about 20 minutes at a time several times a day. ...
  3. Take an over-the-counter pain reliever. ...
  4. Wear proper shoes. ...
  5. Use metatarsal pads. ...
  6. Consider arch supports.
3 Nov 2021

How do I reduce inflammation in my fat pad? ›

Treatment for Hoffa's fat pad syndrome involves reducing inflammation and controlling nerve pinching in your knees. First line of treatment involves rest and medications. Other conservative treatments include taping the knee, performing strengthening exercises, and anti-inflammatory injections.

Can fat pads be restored? ›

Fat pad restoration is a foot treatment that restores the body's natural cushioning to the bottom of the foot. This is done in a variety of ways depending on the cause and location of the pain.

What does fat pad atrophy feel like? ›

Symptoms and telltale signs of fat pad atrophy include: Pain under the heel or ball of the foot when walking on a hard surface without shoes. A burning sensation in the heel or ball of the foot that becomes more severe with activity. Dull aching in the heel.

What happens when the fat pads on feet thin out? ›

Fat pad atrophy refers to the gradual loss of the fat pad in the ball or heel of the foot. This condition is characterized by the thinning of the pad, which exposes the sensitive connective tissues to strain and pressure. As a result, inflammation and micro-tears occur.

Do fat pads hurt? ›

Fat Pad Syndrome will present pain located in the centre of the heel, which can feel like a deep bruise. This condition may also be associated with calcaneal apophysitis (inflammation of the heel bone).

Can you add fat to your feet? ›

Fat grafting to the foot is a potential treatment to help ease pain from fat pad atrophy and chronic plantar fasciitis. In this procedure, doctors harvest fat cells through liposuction from an area of fat excess, such as the belly or thighs.

How do you gain fat on your feet? ›

Wearing high heels or doing high-impact exercise like running drastically increases the total amount of force your feet absorb. The fat pad in the foot is a thick layer that lies on the plantar surface, cushioning the forefoot and heel when it makes contact with the ground.

Is a fat pad serious? ›

Hoffa's fat pad is a normal part of human anatomy, and acts as a shock-absorber to cushion the patella and stop it from hitting off the femur (thigh bone) in the event of a direct blow to the front of the knee. The fat pad has an excellent nerve supply, therefore injury or damage to it can cause significant pain.

Does atrophy hurt? ›

Muscle Atrophy: Signs, Symptoms & Treatments. Muscle atrophy refers to the loss of muscle tissue caused by a long-term lack of physical activity. Individuals with this condition experience mobility issues, pain, and discomfort, reducing their quality of life.

What is atrophy pain like? ›

If you have muscle atrophy in your limbs, you may feel tingling, numbness or weakness in your arms and legs. If you have atrophied muscles in your face or throat, your facial muscles may start feeling weak and you may find it difficult to speak or swallow.

Does atrophy cause burning? ›

Vaginal atrophy (also called atrophic vaginitis) is a condition where the lining of the vagina gets drier and thinner. This results in itching, burning and pain during sex, among other symptoms. The condition also includes urinary tract problems such as urinary tract infections (UTIs) and frequent urination.

What happens when the fat pads on feet thin out? ›

Fat pad atrophy refers to the gradual loss of the fat pad in the ball or heel of the foot. This condition is characterized by the thinning of the pad, which exposes the sensitive connective tissues to strain and pressure. As a result, inflammation and micro-tears occur.

Why do I have no fat on my feet? ›

Causes of Plantar Fat Pad Atrophy (Loss of Fat Pads on Feet): Age is the most common cause, as fatty tissue is reduced in the foot, like it is around the rest of the body. Collapsed long bones in the balls of the feet leading to increase pressure, wearing out the fat pad over time.

Can fat pads be restored? ›

Fat pad restoration is a foot treatment that restores the body's natural cushioning to the bottom of the foot. This is done in a variety of ways depending on the cause and location of the pain.

What does fat atrophy feel like? ›

Symptoms and telltale signs of fat pad atrophy include: Pain under the heel or ball of the foot when walking on a hard surface without shoes. A burning sensation in the heel or ball of the foot that becomes more severe with activity. Dull aching in the heel.

How do I reduce inflammation in my fat pad? ›

Treatment for Hoffa's fat pad syndrome involves reducing inflammation and controlling nerve pinching in your knees. First line of treatment involves rest and medications. Other conservative treatments include taping the knee, performing strengthening exercises, and anti-inflammatory injections.

How do you gain fat on your feet? ›

Wearing high heels or doing high-impact exercise like running drastically increases the total amount of force your feet absorb. The fat pad in the foot is a thick layer that lies on the plantar surface, cushioning the forefoot and heel when it makes contact with the ground.

Can you add fat to your feet? ›

Fat grafting to the foot is a potential treatment to help ease pain from fat pad atrophy and chronic plantar fasciitis. In this procedure, doctors harvest fat cells through liposuction from an area of fat excess, such as the belly or thighs.

What is the pad on the bottom of your foot called? ›

The plantar fascia is the thick tissue on the bottom of the foot. It connects the heel bone to the toes and creates the arch of the foot.

What is plantar fat pad atrophy? ›

Plantar fat pad atrophy describes the breakdown or thinning of the fat pads on the bottom of our feet. These fat pads work to provide cushioning to the bones of our feet and help absorb forces as our feet take on heavy loads each day.

Can hardly put weight on foot? ›

Most likely, plantar fasciitis. This condition begins in the plantar fascia, a thick tissue band that runs along the bottom of the foot and connects your heel to your toes. This tissue band absorbs force impact and supports your weight whenever you stand, walk, run, or jump.

What is atrophy pain like? ›

If you have muscle atrophy in your limbs, you may feel tingling, numbness or weakness in your arms and legs. If you have atrophied muscles in your face or throat, your facial muscles may start feeling weak and you may find it difficult to speak or swallow.

Does atrophy cause burning? ›

Vaginal atrophy (also called atrophic vaginitis) is a condition where the lining of the vagina gets drier and thinner. This results in itching, burning and pain during sex, among other symptoms. The condition also includes urinary tract problems such as urinary tract infections (UTIs) and frequent urination.

How quickly does atrophy set in? ›

Injuries and lack of physical activity

You may ask, “How long does it take for muscles to atrophy?” Experts suggest that muscles start to shrink after four to six weeks of inactivity.

Videos

1. Taping Demonstration: Heel Fat Pad - Todd Davenport | MedBridge
(MedBridge)
2. Amazing treatment for Fat Pad Atrophy, No Surgery!
(West End Foot and Ankle)
3. Heel pain? The fat pad could be to blame!
(ZonaPhysicalTherapy)
4. Taping Fat pad syndrome
(La Clinique Du Coureur)
5. Plantar Fasciitis Vs Heel Pad Syndrome. How to tell what's causing your heel pain
(Prime Health Co.)
6. Heel Pain- Everything You Need To Know - Dr. Nabil Ebraheim
(nabil ebraheim)

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