Fat Pad Atrophy Specialist

Gotham Footcare

Podiatrists located in New York, NY

Fat Pad Atrophy Q & A

What is Fat Pad Atrophy?

Fat Pad Atrophy is a condition that refers to the thinning and loss of the protective fat cushion that sits under the bones in the ball of the foot.  

Fat Pad Atrophy is a normal albeit unfortunate, aging process and is commonly seen in the elderly.  As the shock absorption from the fatty tissue is no longer present to protect the bones in your feet from the ground you stand on, the force and pressure of the body’s weight cannot distribute evenly across the foot.   Weight and pressure subsequently accumulate onto the ball of your foot leading to significant pain, inflammation, and possible damage to the bones and surrounding soft tissues.

Fat Pad Atrophy affects both men and women equally.  However, women are more susceptible to experiencing pain and calluses in the ball of the foot because they are more likely to sacrifice comfort over fashion in their choice of ill-fitting or tight-fitting footgear such as high-heeled footwear.  High-heels shift the body’s center of gravity forward, placing increased load and pressure on the ball of your foot leading to the accelerated progression of fat pad atrophy and subsequent damage.   Fat Pad Atrophy can lead to soft tissue injury in the ligaments and nerves surrounding the ball of the foot.  A callus may develop and if not treated may lead to the formation of ulceration of the underlying tissue.  This can lead to pain in the head of the metatarsals, the five long bones at the bases of the toes, commonly referred to as metatarsalgia, and occasionally fractures of the metatarsals may also occur. 

Although conservative options are available including the use of highly cushioned insoles, they are impractical for extremely stylish shoes and do not eliminate pain in the ball of the foot while barefoot.  If you must wear Christian Louboutin, Jimmy Choo, and Manolo Blahnik, to name a few, you may be a candidate for Fat Pad Restoration.

What are the symptoms of Plantar Fat Pad Atrophy?

  • Pain in the ball of the foot (Metatarsalgia) that worsens with prolonged standing, wearing heels or thin-soled shoes, or when walking barefoot on hard surfaces.
  • Feeling the bones in the ball of your foot without much overlying fatty tissue
  • Feeling as if you are walking with a small rock in the front of your shoe.
  • Formation of thick painful calluses on the ball of the foot.

What are the causes of Plantar Fat Pad Atrophy?

  • Age:  With increasing age, fatty tissue deteriorates and the formation of new tissue decreases in the foot as it does throughout the body.
  • Anatomy:  Certain anatomical characteristics, such as high arches can result in fat pad atrophy as increased pressure and weight accumulates in the ball of the foot. 
  • Collapsed Metatarsals:  Depression of the metatarsal heads can wear out the fat pad protecting the area over time and cause increased pressure on the ball of the foot.
  • Diabetes: Thinning and loss of fat pad are common especially if you suffer from neuropathy.   
  • Footwear: As previously discussed, footwear selection or walking barefoot can initiate or exacerbate fat pad atrophy.
  • Genetics:  Some people can inherit the predisposition to lose fat pads on their feet.
  • Injury or Surgery:  Injury to the ball of the foot from activity or previous surgery can lead to displacement and deterioration of the fat pad.
  • Overpronation: Excessive flattening of the arch can place increased pressure on the ball of the foot.
  • Medications:  Chronic use of steroids are also known to cause fat pad atrophy.
  • Rheumatoid Arthritis: Clawing of the toes associated with this condition causes the head of the metatarsals to become more prominent towards the balls of the feet.
  • Steroid Injections: Frequent Steroid injections in the foot can cause fat pad atrophy.

What is the Treatment for Plantar Fat Pad Atrophy?

  • Avoid activities that place increased pressure on the balls of the feet such as squatting, repetitive or high-impact exercises.  Switch to low-impact alternatives, such as cycling, swimming, or non-weight-bearing weight training.
  • Avoid high heels and limit heel height to an inch or less.
  • Avoid walking barefoot
  • Wear custom-molded orthotics to distribute weight evenly across the soles of the feet while providing adequate shock absorption and comfort.
  • Wear supportive footwear that also provides cushioning to the feet.
  • Injection of Collagen DermaFillers such as Sculptra into the areas of soft tissue atrophy for increased cushioning of the ball of the foot. Relief of pain can last six to 12 months depending on the specific product used.

What is Sculptra?

At Gotham Footcare, Sculptra Injections are available for patients who have pain in the ball of the foot, bony prominences, and/or recurrent calluses.   Your doctor may recommend injecting Sculptra to add volume to the ball of your foot to create a soft, natural cushion underneath your bones.  Sculptra is safe and has received full FDA approval for cosmetic use in the United States in 2009.  Sculptra Injections provide foot relief in as few as one visit.

The liquid consists of a synthetic lactic acid that is made in a laboratory and contains no animal or human DNA derivatives. Sculptra will gradually disappear over time as a result of your own cellular breakdown, but results typically last up to two years.

You will notice an immediate increase in tissue volume after your first visit.  Your body may actually produce even more collagen in the next 90 days following your injection, which may lead to increased volume and comfort in the ball of your foot.  It is normal to experience some minor bruising and swelling, which should only last up to a week.

Overall, Sculptra:

  • Lessens Metatarsalgia (Pain under the ball of the foot)
  • Lessens callus formation
  • Reduces foot, ankle, knee, hip, and back pain.
  • Reduces foot fatigue and muscle cramping
  • Provides lasting results for up to two years

This minimally invasive office procedure is suitable for both women and men and provides relief of pain and cushioning of bony prominences in the feet.  Depending on the amount of correction necessary, typically only one procedure is necessary per year to maintain the correction.

There is minimal downtime post-injection, and if side effects are experienced, they are generally minimal and short-lasting. There is a slight chance that you may temporarily develop small, invisible bumps.  However, these bumps are very rare, they typically resolve on their own, and can be easily remedied with a small injection of anti-inflammatory medication.

If you are dealing with pain in the ball of your foot it may be due to fat pad atrophy.  The board-certified doctors at Gotham Footcare can help you find the right treatment option for pain in the ball of the foot, so contact us today to learn more.