How to Treat Painful Fat Pad AtrophyHow to Treat Painful Fat Pad Atrophy in the Foot

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.

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.

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.

 

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.

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

  • 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.