Why do our feet lose padding as we age. What are the signs of fat pad atrophy in feet. How can foot padding loss be treated effectively. What causes thinning of fat pads in heels and ball of foot. Are there ways to prevent loss of foot cushioning over time.

Understanding Fat Pad Atrophy in Feet

Fat pad atrophy refers to the gradual loss of protective fatty tissue in the heel and ball of the foot. This condition can lead to significant discomfort and impact daily activities. As we age, the natural cushioning in our feet tends to diminish, exposing sensitive tissues to increased pressure and strain.

The fat pads in our feet serve a crucial purpose – they act as shock absorbers, helping to distribute pressure evenly across the foot with each step. On an average day, our feet bear a collective load of hundreds of thousands of pounds. In fact, during normal activities, feet absorb a total force of around 26,000 pounds. High-impact exercises or wearing high heels can dramatically increase this force.

Why is foot padding important?

Foot padding is essential for several reasons:

• Shock absorption: Cushions impact when walking or running
• Pressure distribution: Spreads force evenly across the foot
• Protection: Shields bones and soft tissues from excessive strain
• Comfort: Allows for pain-free movement throughout the day

Causes of Fat Pad Atrophy in Feet

There are several factors that can contribute to the loss of foot padding over time:

Age-related changes

As we get older, the natural fat pads in our feet tend to thin out. This age-related atrophy is a common cause of reduced cushioning in the heels and balls of the feet.

Repeated injections

Multiple corticosteroid injections used to treat conditions like plantar fasciitis can sometimes lead to fat pad atrophy as a side effect.

Chronic overloading

Consistently putting excess pressure on certain areas of the foot can cause padding loss. This may occur due to:

• Regularly wearing high-heeled shoes
• Being overweight or obese
• Participating in high-impact sports

Foot deformities

Conditions like hammertoes can alter the distribution of fat in the foot. Dr. Samuel Russ, a foot and ankle surgeon at Summit Orthopedics, explains: “People who chronically overload the ball of their foot can get hammertoes. That condition can draw the fat pad toward the toes, leaving less padding in the area that takes the weight.”

Recognizing the Signs of Foot Padding Loss

Identifying fat pad atrophy early can help in managing the condition more effectively. Common symptoms include:

• Pain in the affected areas (heel or ball of foot)
• Development of thick calluses
• Increased sensitivity when walking barefoot on hard surfaces
• Feeling the bones in your feet more prominently
• Discomfort or pain when wearing high heels
• Persistent foot pain despite regular pedicures or foot care

Is foot pain always a sign of fat pad atrophy?

While foot pain can indicate fat pad atrophy, it’s important to note that other conditions can cause similar symptoms. Always consult with a podiatrist or orthopedic specialist for an accurate diagnosis.

Diagnosis and Assessment of Fat Pad Atrophy

Proper diagnosis of fat pad atrophy typically involves a combination of physical examination and imaging studies. Here’s what you can expect during the diagnostic process:

Physical examination

A foot specialist will examine your feet, looking for signs of thinning fat pads, calluses, and any visible deformities. They may also assess your gait and how you distribute weight across your feet.

Imaging studies

X-rays or ultrasound imaging may be used to visualize the internal structures of your feet and measure the thickness of the fat pads. In some cases, MRI scans might be recommended for a more detailed view.

Pressure mapping

Advanced diagnostic tools like pressure mapping systems can provide valuable insights into how pressure is distributed across your feet when standing or walking.

Treatment Options for Fat Pad Atrophy

While fat pad atrophy can be challenging to treat, several options are available to manage symptoms and improve comfort:

Conservative treatments

Non-surgical approaches are often the first line of treatment for fat pad atrophy:

• Orthotic devices: Custom shoe inserts can help redistribute pressure and provide additional cushioning
• Heel cups or gel pads: These can add extra padding to shoes
• Calf stretching exercises: Dr. Russ emphasizes the importance of this, stating, “Most people have tight calf muscles. This can alter your heel strike so you strike your heel in the place where you have the least padding. Stretching the calf back out can be helpful in restoring comfort.”
• Footwear modifications: Choosing shoes with proper cushioning and support

Surgical interventions

In severe cases where conservative treatments aren’t effective, surgical options may be considered:

• Heel cord lengthening: This procedure can help address issues related to tight calf muscles
• Fat grafting: In some cases, fat from other parts of the body may be transferred to the feet to restore cushioning
• Correction of foot deformities: Addressing underlying structural issues can help redistribute fat pads more effectively

Regenerative therapies

Emerging treatments like platelet-rich plasma (PRP) injections or stem cell therapy show promise in promoting tissue regeneration, though more research is needed to establish their long-term efficacy.

Preventing Fat Pad Atrophy in Feet

While some degree of fat pad thinning is a natural part of aging, there are steps you can take to minimize its impact:

Maintain a healthy weight

Excess body weight puts additional stress on your feet, potentially accelerating fat pad atrophy. Keeping your weight in check can help preserve foot padding.

Choose appropriate footwear

Opt for shoes that provide adequate cushioning and support. Limit the use of high heels and avoid going barefoot on hard surfaces for extended periods.

Use protective padding

Consider using cushioned insoles or metatarsal pads to provide extra protection for vulnerable areas of your feet.

Practice good foot hygiene

Regular foot care, including moisturizing and gentle exfoliation, can help maintain healthy skin and potentially slow the progression of fat pad atrophy.

Living with Fat Pad Atrophy: Lifestyle Adaptations

For those dealing with fat pad atrophy, certain lifestyle changes can significantly improve comfort and mobility:

Activity modifications

Consider low-impact exercises like swimming or cycling to reduce stress on your feet. If you enjoy high-impact activities, gradually increase intensity and duration to allow your feet time to adapt.

Regular foot care routine

Develop a daily foot care regimen that includes gentle massage, stretching exercises, and the use of moisturizing creams to keep the skin supple.

Footwear rotation

Alternate between different pairs of shoes to vary pressure points and reduce consistent stress on specific areas of your feet.

Regular check-ups

Schedule periodic visits with a podiatrist or orthopedic specialist to monitor the condition of your feet and adjust treatment plans as needed.

Understanding and addressing fat pad atrophy is crucial for maintaining foot health and overall quality of life. By recognizing the signs early, seeking appropriate treatment, and making necessary lifestyle adjustments, individuals can effectively manage this condition and continue to stay active and comfortable on their feet.

Do Our Feet Lose Padding as We Get Older?

Summit Orthopedics foot and ankle surgeon Samuel Russ, M.D., gives his insight into how feet can lose foot padding over time and what we can do about it.

Our feet work hard for us as we go about our daily activities. With every step, our heels absorb three times our body weight and transfer some of that pressure to the balls of our feet as we prepare to take the next step. To deal with this repeated pressure, our feet have thick pads of fat under the skin of our heels and our metatarsals (the medical term for the ball of the foot). But what happens if those fat pads thin out? Do our feet lose padding as we get older?

The short answer, according to Summit Orthopedics foot and ankle surgeon Samuel Russ, M.D., is yes. “People can lose padding in the heel fat pad, which is important for absorbing the heel strike as you walk,” Dr. Russ said. “They can also lose padding underneath the metatarsals. That’s important for when you toe off at the end of each step. ”

Why we lose foot padding

There are a few reasons that our feet might lose padding over time. “Some of it is age-related atrophy,” Dr. Russ said. If an individual has had many injections in the heel to treat plantar fasciitis, that could lead to a loss of padding as well.

Another potential cause is chronic overloading in the ball of the foot. This can happen for a variety of reasons, everything from wearing high-heeled shoes every day to being overweight. “People who chronically overload the ball of their foot can get hammertoes,” Dr. Russ said. “That condition can draw the fat pad toward the toes, leaving less padding in the area that takes the weight.”

Signs of loss of fat padding in the heel or ball of the foot include pain in the affected area, development of thick calluses on the heel or ball of the foot, and feeling the bones within your feet more easily.

Ideas to treat loss of foot padding

Heel fat pad atrophy can be a tough problem to treat. Treatment options include shoe inserts, heel cups, or gel pads to add some cushion in the shoe.

Another effective treatment is stretching the calf. “Most people have tight calf muscles,” Dr. Russ said. “This can alter your heel strike so you strike your heel in the place where you have the least padding. Stretching the calf back out can be helpful in restoring comfort.”

If these nonsurgical options are not effective and the pain is severe, a foot and ankle surgeon may be able to perform surgery to lengthen the heel cord and help address the issue.

For fat pad loss in the ball of the foot, treatment options include an orthotic device to offload that area as well as calf stretching. “If the heel lifts off before it should because the calf is tight, that puts more load on the ball of the foot,” Dr. Russ said.

If there is an overarching foot deformity causing the fat pad to move out of place, correcting the problem surgically is also an option.

More resources for you:

• Meet Dr. Russ in this introductory video.
• Learn how to avoid developing foot problems.
• Check out part 1 and part 2 of our “Why Do My Feet Hurt?” series.
• Learn how our footprints can indicate foot health.
• Watch this video on the difference between foot sprains and fractures.
• Take a look at this common foot and ankle sports injuries video.

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No Fat on the Bottom of Your Feet? What You Need to Know About Fat Pad

Do your feet feel painful after you walk on a hard surface without shoes? Are high-heels completely out of the question due to intense pain? Do you always seem to have calluses, regardless of how many pedicures you get? If so, you might have fat pad atrophy.

Losing fat is often the topic of conversation on health blogs for reasons like improved health, better cardiovascular fitness, boosted confidence, and more. But in the case of fat pad atrophy in the feet, that isn’t the case. In fact, when you lose the fat on your feet, you are faced with persistent pain that can prevent you from living a happy and fulfilling life.

Today we’re going to do a deep dive into fat pad atrophy. What is fat pad atrophy? Why is there fat on the bottom of your feet? What are the symptoms and causes of this condition? And finally, what you can do about it.

What is fat pad atrophy?

Fat pad atrophy is the gradual loss of the fat pad in the ball or heel of the foot. This thinning of the fat exposes the sensitive connective tissues to strain and pressure. It’s essential to have fat pads on the feet, because these act as cushioning to soften the impact of your feet hitting the ground every day.

During a typical day, your feet bear the collective load of hundreds of thousands of pounds. On average, your feet absorb a total force of 26,000 pounds. 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. This function is necessary, helping to shield the feet from damage and repeated stress.

When plantar fat pad atrophy occurs, it can be devastating. Inflammation and micro-tears occur. This leads to intense pain and confusion, as oftentimes, the source of the pain isn’t clear. Severe atrophy can prevent you from walking or standing on your feet for long periods of time, because the impact is taking its toll.

Fat pad atrophy is often associated with heel pad syndrome. This is a pain that occurs in the center of the heel, but is due to fat pad atrophy. Heel pad syndrome can present alongside plantar fasciitis.

What does fat pad atrophy feel like?

● Pain under the heel or ball of the foot

● Difficulty walking on a hard surface without shoes

● A burning sensation

● Dull ache

● A sensation that you are stepping on pebbles

What are other symptoms of fat pad atrophy?

Aside from the aforementioned symptoms associated with pain, fat pad atrophy is linked to other symptoms. For example, if you have chronic calluses on your feet, it may be indicative that the fat is thinning. In the case of heel pad syndrome, if you have been diagnosed with plantar fasciitis, this can be connected to fat pad atrophy.

Many people with this condition have reported a feeling that they are walking “directly on the bone” and even hearing the bone make contact with the ground with each step. As unpleasant as this sounds, it’s a tell-tale indicator of fat pad atrophy.

You may be asymptomatic. You may only consider there to be an issue after performing high-impact exercise or standing on your feet for an extended period of time. If this sensation occurs, don’t ignore it, to prevent it from getting worse.

What are the risk factors for fat pad atrophy?

● Obesity – The increased load from excess body weight can cause the fat pad to lose its protective resiliency.

● Plantar fasciitis – Studies show that having plantar fasciitis is linked to a thinner metatarsal fat pad.

● Rheumatoid arthritis (RA) – RA is associated with atrophy of the muscles, cartilage, bones and fat tissue, caused by inflammation. This happens all around the body, and the feet are no different.

● High-impact exercise – High-impact exercise like running or jumping can cause the thinning of fat pads over time. This aggravates the foot, and can exacerbate the loss.

● Wearing high-heels – Wearing high-heels shifts your weight to the front of your weight, placing excessive mechanical stress and pressure on the balls of your feet. In general, wearing poorly cushioned shoes can also exacerbate this condition.

How to treat fat pad atrophy

The first point-of-call is to meet with a podiatrist to get the condition diagnosed. If fat pad atrophy is severe, it will require medical intervention to treat it most effectively.

If you want to try and treat this condition yourself, the first thing you need to do is to replace the fat pad with shock absorption from the outside of the foot. In short, wear better shoes. Look for shoes with added cushioning. This will give your feet the support they need so the wearing down of the pads starts to halt. This may give your feet the chance to repair themselves naturally, rebuilding the fat tissue that has been lost.

Wearing orthotics or shoe inserts is a go-to treatment for many podiatrists. As stated by John Steinberg, DPM, chief of podiatric surgery at Medstar Georgetown Hospital in Washington, DC. “Conservative treatment can be quite successful; it can ease pain and prevent symptoms from getting worse.” Simply getting insoles for your shoes that you wear on a daily basis can help to give your feet a break, to repair. Click here to shop for custom insoles.

Steinberg can be quoted again to say, “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.” The goal is to give your feet what they are lacking – cushioning! They

don’t have to be ugly orthopedic shoes either – check out the fashionable range of shoes

In severe cases, you may have to treat fat pad atrophy with fat grafting. While it is effective, most patients prefer to use this as a last resort.

without statute of limitations e-mail.indd

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