Fat Pad Atrophy

The fat pad of the foot is the thick connective tissue that runs under the ball of the foot and the heel. It cushions the effect of strain and pressure on the foot. It also provides a mechanical anchor during weight transfer. Over time, the shearing forces can cause the fat pad to atrophy and lead to discomfort in moving.

What Is Fat Pad Atrophy?

Fat pad atrophy is a common condition that affects the feet. It is the progressive thinning out of the fat pad at the ball and heel of the foot. Consequently, it exposes sensitive connective tissues to more strain and pressure, leading to inflammation and micro-tears.

Fat pad atrophy occurs naturally with aging, but it can also be fast-tracked by several pathological and lifestyle factors. Let’s consider what causes fat pad atrophy, its symptoms, risk factors, complications, and how to treat the condition.

Causes of Fat Pad Atrophy

Given how common fat pad atrophy is, it's important to understand the causes of this condition and limit those within your control. Highlighted below are four of the leading causes of fat pad atrophy:

1. Age The older you get, the more the fatty tissue in your foot degenerates, as it does in other areas of your body.
2. Overpronation If your foot rolls inwards excessively while walking, the pressure on the ball of the feet increases. In turn, the fatty tissue atrophies quickly.
3. Structural abnormality of the foot Structural abnormalities like a high arch and flat feet lead to an increase in pressure passing through the balls of the feet.
4. Fracture of the foot bones This leads to a thinning and displacement of the fat pad.

Symptoms of Plantar Fat Pad Atrophy

If the symptoms of plantar fat pad atrophy are identified early, then you can work to limit its progression. The most common symptoms and signs of fat pad atrophy include:

• Pain The thinning of the fat pad in the foot causes the heel bone and tarsal bones to bear more weight, directly causing pain. Pain is often described as dull and aching and may increase with more activity.
• A burning sensation You may also feel a burning sensation in the heel or ball of the foot if there is nerve compression due to the fat pad atrophy.
• Discomfort in the heel You may experience discomfort while walking as you feel your heel bone or bones under the ball of your feet.
• Hearing a knocking sound A possible indicator of fat pad atrophy is hearing a knocking sound instead of a soft patter when walking on hard surfaces.

Who Is at Risk of Getting Fat Pad Atrophy?

Apart from the direct causes of fat pad atrophy, there are also factors that fast-track the thinning and degeneration of the fat pad. Here are some of the risk factors:

• Incorrect footwear Wearing high heels, ill-fitting shoes, and shoes with poor cushioning can increase your chances of developing this condition.
• Injury Injuries after an accident are common triggers of fat pad atrophy, especially if several surgeries are performed in the foot area.
• Family history If you have a family history of fat pad atrophy, you’re more likely to experience it, as genetics seem to play a significant role in developing the condition.
• Arthritis Arthritis causes inflammation of the joints and increases the risk of fat pad loss. Furthermore, rheumatoid arthritis causes clawing of the toes and makes the bones of the balls of the feet more prominent.
• Diabetes Patients with diabetes often develop a complication known as peripheral neuropathy—nerve damage caused by high blood sugar. The neuropathy causes atrophy of the foot pads and increases the risk of developing a foot ulcer.
• Medications Adults who use corticosteroids are more predisposed to fat pad atrophy because the corticosteroids can induce fat loss.

Complications Associated With Fat Pad Atrophy

Without treatment, fat pad atrophy can lead to complications. Hence, it is vital to treat the condition as soon as possible to restore the footpad cushioning and improve comfort and mobility. Some of the complications include:

• Foot ulcers
• Stress fractures
• Calluses
• Edema in the feet
• Falls and injuries

Treatment Options for Fat Pad Atrophy

Treatment for fat pad atrophy can be either conservative or surgical.

Conservative Treatment

Conservative treatment aims to relieve pain, improve shock absorption, and slow down the progression of fat pad loss. Conservative treatment involves the following:

• Use of proper footwear Instead of ill-fitting and high-heeled shoes, aim to wear properly cushioned shoes with supportive soles or insoles to reduce the pressure on the foot and thus slow down fat pad atrophy.
• Custom orthotics Ideally, a custom-molded orthosis will provide external cushioning for the feet and help improve shock absorption. They also help ensure the even distribution of weight to the soles of the feet. While this doesn’t slow down the atrophy, it can help limit any adverse symptoms from the increased pressure on the foot. Purchasing custom orthotics is not as difficult as you may think, as there are many avenues to buy custom orthotics online.
• Activity modification After the onset of fat pad atrophy, you should avoid walking barefoot. You may also consider switching from high-impact exercises like jumping and running to low-impact exercises like cycling and swimming.
• Cushioned socks Cushioned socks also reduce the impact of walking on the feet.
• Injectable fillers Fillers can be injected into areas of the foot that bear high pressure. It is often used in cases that are not very advanced. It is mostly painless and can give immediate results. However, sometimes the fillers migrate from the injection point, and the symptoms can multiply and worsen.
• Physiotherapy The physiotherapist will ask you to do a series of activities, including mobilization, foot stabilization, balance, and coordination exercises. The physiotherapist will also help you address any biomechanic challenges with foot position and increase neuromuscular control.

Surgical Treatment

If conservative treatment cannot slow down the atrophy of the fat pad, surgical intervention is a last-gasp measure. The surgical approach can either be a fat pad graft or transfer.

Both are reconstructive surgeries that promote tissue repair and stimulate the body to provide more fat. Your podiatrist will assess the level of atrophy of the foot pad and decide what kind of surgery will be the most effective treatment.