Fat pad atrophy may sound strange, but it’s a more common condition than most people realize. It can happen to you without you even realizing and can cause pain on various parts of your foot, affecting your daily life and activities.
The good news is that if you catch it early and take steps to ease the symptoms, you can stay pain-free for much longer.
Here’s everything you need to know about fat pad atrophy, including symptoms, treatments, and prevention.
What Is Fat Pad Atrophy?
Fat pad atrophy—also known as fat pad syndrome—is a foot condition in which the fatty cushioning under the ball of the foot and in the heel begins to wear down and gets thinner.
This results in the fat pads providing less effective protection for the underlying bones and nerves. Continuing to walk on the feet with less protection results in pain, due to the body weight being concentrated on the unprotected bones of the feet.
Fat pad atrophy is most often seen in elderly people, but can affect anybody of any age due to a combination of factors.
The Purpose of the Fat Pad
We have natural fat pads underneath both the balls of the feet and in the heel. These act as shock absorbers when we walk as the ball of the foot and heel are the parts of the feet that take the most impact.
The fat pads also protect the bones of the forefoot and heel from direct contact when you walk or run.
These pads also anchor the foot and help you to easily shift your body weight. As the fat pad compresses, it spreads out, distributing your body weight more evenly and allowing you to shift without injuring the tissues in your foot.
How to Measure the Fat Pad
It’s difficult to measure your own fat pad and it’s usually done by X-ray or ultrasound at the reference of your foot doctor.
Everybody’s feet are different, so there’s no right or wrong thickness for a heel or ball of foot fat pad.
However, a normal fat pad typically measures 0.4 to 0.8 inches—1 to 2 centimeters—in thickness.
In most cases, when the fat pad reduces to less than a centimeter—0.4 inches— in thickness and is accompanied by pain, it can be considered to be atrophied.
Symptoms of Fat Pad Atrophy
The first symptom of fat pad atrophy is pain in the area of the fat pad. It may present as a sharp, shooting pain, a burning pain, or a dull ache, and could be accompanied by an uncomfortable feeling like there’s a small rock in your shoe.
This pain will increase when standing, walking, or with other activity and will ease up when you rest the affected foot.
The pain will also increase if you ‘re wearing shoes that don’t provide support or cushioning in the ball of the foot or heel.
You may be able to feel your metatarsal bones when feeling the fat pad of your foot. You might also notice that hard calluses are forming on the ball of your foot.
The exposed bones and calluses may cause a tapping or knocking sound when you walk barefoot on a hard surface.
In advanced cases, you may find that the pain doesn’t diminish when resting and you have pain when you’re off your feet.
Causes of Fat Pad Atrophy
Age is a big factor in the development of fat pad atrophy. As one ages, the fatty tissue that the body uses as protection naturally diminishes and new tissue doesn’t develop as readily.
The fat pads on the forefoot and heel are prone to rapid deterioration as one ages due to the repetitive motion of walking, running, jumping, and other natural motions that place stress on the feet.
Wearing footwear with inadequate padding in the forefoot and heel can speed up fat pad atrophy.
Women who wear high heels may be more at risk of developing fat pad atrophy in the ball of the foot as they place extra pressure on the metatarsals.
Those who spend a lot of time standing, walking, or running on hard surfaces may be at higher risk of developing fat pad atrophy.
As your foot lands on the hard surface, the repetitive nature of the movement can place excess force on the heel and ball of the foot, accelerating fat pad atrophy.
Collapsed metatarsals due to injury or overuse may cause the fat pad to wear out faster, leading to pain and increased pressure on the ball of the foot.
When one metatarsal bone—or more—moves out of place, it places excess pressure on the nerves and can lead to pain.
It may also cause you to change your gait, leading to your body weight being distributed unevenly on your forefoot. This can accelerate the wearing out of the fat pad.
Those who overpronate and don’t wear the correct shoes are at an increased risk of developing fat pad atrophy in the ball of the foot.
When your shoes don’t support your arch, your arch flattens excessively when you walk. This places excess stress on the ball of the foot, which over time can lead to atrophy of the fatty pad.
People who suffer from diabetes are more likely to develop fat pad atrophy, especially if their condition has developed to diabetic neuropathy.
Although it’s not certain why this is, it could be due to a change in gait as one accommodates a loss of feeling in their feet.
People who suffer from fat pad atrophy could also be genetically predisposed to the condition. However, this can be difficult to diagnose unless others in the family have previously been diagnosed with the condition.
Injury or Surgery
Injury—overuse or trauma—to the bottom of the foot can cause the fat pads underneath the foot to move out of place. This leads to impaired protection on either the ball of the foot or the heel.
Surgery to the foot can have the same effect. Both injury and surgery can also lead to a change of gait, which causes pressure to be distributed differently and can cause fat pad atrophy over time.
People who use steroids are more at risk of developing fat pad atrophy. Steroids target fat cells, which can inadvertently lead to the reduction of the fat pads in your feet. Medical corticosteroid injections in the foot can also lead to fat pad atrophy.
Those with rheumatoid arthritis are prone to developing claw toes, which can cause the metatarsal heads to move out of position. This can compromise the protection of the fat pad and lead to it wearing away faster.
Treatments of Fat Pad Atrophy
Custom Insoles and Taping
Using custom insoles to provide the right type of support for your feet is essential for preventing pain from fat pad atrophy.
If you can, you should buy new shoes with more adequate cushioning for your heel and forefoot, as well as excellent arch support.
However, if buying new shoes isn’t an option, you should invest in custom insoles. You can buy over-the-counter insoles, but it’s recommended to get custom-made insoles that provide the perfect support and correct cushioning for your feet.
You can tape your feet—ball of the foot and heel—to help keep the fat pads from moving. Taping the ball of your foot can help to provide support for the fat pad and prevent it from moving out of position while you’re walking.
You can do the same for the heel. However, this is a temporary measure that may help to relieve pain but it should be used in conjunction with cushioned, supportive footwear.
Improve Foot, Ankle, and Lower Leg Muscle Control
Improving the strength of your foot muscles and joints, as well as the muscles around them, can help to reduce the pain associated with fat pad atrophy.
Strengthening your muscles and joints with stabilization and strength exercises can help to prevent a change in gait, which is a common reason for acceleration of fat pad atrophy.
Like taping, this should be done along with other measures for the best chance of success.
Gradually Increase Load on Tissue
If you play sports, your first form of treatment should be to ensure that you’re wearing protective, cushioned, and supportive shoes.
Then, you should gradually increase the load on the tissues to help you get back to full function safely and under control.
Slowly add sport-specific dynamic exercises to ensure that you are not overloading the tissues and causing more damage.
Plyometric training can help to build strength and resilience in the affected tissues, if you’re wearing the right kind of footwear.
For less advanced cases, injectable fillers can be used to plump up the fat pad and provide the protection that has been lost. This is more common in less advanced cases.
Fat Pad Surgery
Surgery is often done as a last resort. A fat graft is done on the fatty pad in either the ball of the foot or the heel, using the person’s own fat transferred from another part of their body.
The surgeon will source fat from the stomach or buttocks, remove it, and graft it onto the foot in the place of the atrophied fat pad. This means there’s no chance of the body rejecting the cells.
However, many doctors will only perform this kind of surgery in severe cases and usually only if all other options have been exhausted.
How to Prevent Fat Pad Atrophy
Although fat pad atrophy cannot be reversed, if you haven’t yet started developing symptoms you can take steps to prevent it from happening.
Wear Proper Footwear
You can prevent fat pad atrophy by wearing the right kind of footwear. Ensure that your shoes have excellent cushioning in both the ball of the foot and the heel, in order to absorb shock and reduce pressure on the fat pads.
You should also choose shoes with adequate arch support to prevent overpronation or incorrect body weight distribution.
Avoid wearing high heels or other shoes that place excess pressure on the balls of the feet. You should also avoid walking barefoot as there’s no protection for the fatty pads when you’re not wearing shoes.
Wear Custom Orthotics
If your shoes don’t provide adequate cushioning and support, you can try using custom orthotics. A podiatrist will be able to design an insole for your foot, which will provide support in the right places.
You can buy over-the-counter insoles, but custom insoles will be more effective at preventing fat pad atrophy and pain in the heel and ball of the foot.
Try Low-Impact Activities
You should consider switching to low-impact activities rather than high-impact sports. Swimming, cycling, and weight training that doesn’t bear a load on the feet are good choices.
You should avoid doing any kind of activity that places pressure on the balls of the feet. Consider alternatives for any high-impact activity you do.
Maintain a Healthy Weight
Excess weight will place unnecessary stress on the fat pads, both in the heel and the ball of the foot.
Reducing your weight can alleviate pressure on the fat pads of the feet and help them to distribute your body weight properly, reducing pain.