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.

Fat Pads Atrophy Syndrome | Well Heeled Podiatry in Hampton

Is a condition that refers to the loss of fat pads in the balls of the feet, which causes thinning of the protective cushioning that sits under the bones.

This is commonly seen in elderly people causing significant pain while walking, as the shock absorption from the fatty tissue is no longer there.

Without the fat pads the whole bodyweight shifts onto these bones with minimal to no protection.  Therefore the load under this area is unable to be spread out effectively leading to pain, inflammation and over time possible damage to the bones.

Although plantar fat pad atrophy effects both men and women equally, the choice of footwear makes women more susceptible to developing pain and callouses on the ball of the foot. Callus that is not treated may lead to ulceration of the underlying tissue.

Similarly, there is a fat pad under the heel bone, as we stand or walk, the body weight is transferred through the heels and ball of the foot, so both these areas need protection.

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.
• Wearing high heels, walking barefoot or in very thinned soled shoes may initiate or exacerbate the condition.
• Extremely high arches are increase weight goes through the balls of the feet.
• Excessive pronation (rolling in) as increased pressure is put on the balls of the feet.
• Injury to the ball of the foot, multiple surgery incisions or fractures can lead to thinning and displacement of the fat pad.
• Genetics are considered to be a cause behind excessive loss of fat pads on feet.
• Rheumatoid arthritis, which causes clawing of the toes and more prominent bones in the balls of the feet.
• There is often thinning and loss of fat pad on feet in people with diabetes especially if they have neuropathy (no feeling), which increases the risk of developing foot ulcers.

Symptoms of Plantar Fat Pad Atrophy (Loss of Fat Pads on Feet):

• Experiencing pain in the ball of the foot, worse when barefoot, in heels or thinned soled shoes.
• Pain which is greater when standing and relieved when sitting.
• The feeling of having a small rock in the shoe.
• Callouses may appear and become very thick on the ball of the foot.
• When feeling the balls of the feet, you can feel the bones without much overlying fatty tissue.

Treatment for Fat Pad Atrophy (Loss of Fat Pads on Feet):

• Avoid activities that require walking on tiptoes, squatting, walking down a slope or any action that puts pressure on the balls of the feet, this includes high heel wearing.
• Wear low heels (an inch or less) and avoid barefoot walking.
• Switch high impact weight bearing exercise to low impact alternatives, such as cycling, swimming and pool running.
• Supportive orthotics with a soft top cover to evenly distribute weight to the soles of the feet, and provides adequate shock absorption and comfort.
• Soft paddings may also be beneficial and suggested by your podiatrist.
• Wear supportive footwear that also provides cushioning to the feet.

Surgical Treatment

If conservative methods of treatment fail, surgery may be an option, although this is rarely the case.

Surgery will involve correcting any collapsed long bones in the balls of the feet and securing with a pin. Fillers may be used to replace the fat pad; however this is not common practice.

This is not a commonly encountered condition, but is frequently misdiagnoses. 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).

The thick pad between the skin and the bone of the heel is called a ‘fat pad’ because it’s made up primarily of fatty tissue. This fat pad aids in the cushioning and shock absorption of the heel bone.

This fat pad is kept in place by fascia, if this structure becomes stretched or damaged the fat pad can spread out reducing the cushioning under the heel, resulting in Fat Pad Syndrome.

Causes of Fat Pad Syndrome:

• Trauma from landing heel first on a hard surface (after a jump or fall).
• Prolonged standing or walking on hard surfaces with inappropriate thinned soled footwear.
• Age can cause the fat pad to flatten, reducing its ability to absorb shock and protect the heel bone.
• Excessive heel strike with poor footwear can damage the fat pad.
• Overweight, as this leads to increased pressure and shock going through the fat pad.

Symptoms of Fat Pad Syndrome:

• Deep, dull ache that  feels like a bruise in the middle of the heel, when standing or walking.
• Pain is aggravated by walking barefoot, or on hard surfaces.
• Unlike plantar fasciitis, fat pad related pain is felt more at the outer side of the heel during heel strike.
• MRI investigations will reveal changes in the fat pad showing signs of swelling.

Treatment for Fat Pad Syndrome:

• Taping the heel to hold the fat pad in place, providing more protection to the bone. If symptoms subside your diagnosis of fat pad atrophy have been confirmed
• Deep heel cups to hold the fat pad in place, ordered from your podiatrist.
• Heel pads may also be used to add extra cushioning (foam or gel).
• Anti-inflammatory medication and icing may help for flare ups.
• Stretching and strengthening program customised by your podiatrist.
• Supportive footwear with firm heel counters and midsoles, that provides heel cushioning.
• Chronic cases may need to be treated with custom foot orthoses with a deepened heel cup to stabilise the bones of the feet and provide more restricted fat pad containment, heel protection and cushioning.

Well Heeled Podiatry will undertake an initial assessment to diagnose and identify the cause of your injury. The podiatrist will help reduce your pain, accelerate healing and increase cushioning to the heel so that you can get back to your activities of daily living with more confidence.

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