Managing Fat Pad Atrophy

Updated: Aug 13, 2018

​​As people age, they often lose the fat, or cushion, underneath their feet, making certain areas (e.g. the balls of the feet and heels) more prominent and painful. Increased mileage and years of pounding on the feet are not the only things that can cause fat pad atrophy, though. Having repeated steroid injections in the foot, such as for plantar fasciitis or a neuroma, can also cause atrophy of the underlying soft tissue structures. People with higher arches are at greater risk for having associated pain since the balls of their feet and heels bear much of their body weight when standing and walking.

Signs/Symptoms: Pain with Fat Pad Atrophy​​

People will notice pain along the balls of their feet and/or heels. The pain is present when walking or standing on their feet and worse while barefoot or wearing high-heeled shoes. Walking on harder ground, such as cement or hardwood floors, will also exacerbate the symptoms.

When the cushion is lost, the bony areas underneath the foot become more prominent, so you may even feel them. Over time, calluses may also develop along these areas.

Treatment Options

There are several different ways to managing of fat pad atrophy. It comes down to three different techniques: padding, offloading, or restoring the lost cushion.

1. Padding

Use of padding is a noninvasive way to restore cushion underneath the feet, externally. This means wearing tennis shoes as much as possible and avoiding barefoot walking, even inside the home. The current insoles can be replaced by more cushioned over-the-counter shoe insoles. I personally like (and use) Spenco RX Comfort Insoles. These are flat insoles, so they will not provide arch support, but just cushion underneath the feet. If cushion is solely under localized areas, flat heel cups/cushions or *metatarsal cushions can also be purchased.

2. Off-loading​​

The purpose of off-loading the prominent area is to distribute the pressure elsewhere. This is more commonly done along the ball of the foot. A *metatarsal pad (left picture at right) can be placed just proximal (or behind) the prominent area. When weight-bearing, the pressure will be placed on the pad, off-loading the prominent area. Similarly, a *horseshoe pad (far right picture) can be used if just one metatarsal bone is bothersome. This type of pad is placed around the bony prominence. Lastly, orthotics can be used to distribute the pressure more evenly underneath the entire foot. Metatarsal pads and other modifications can also be incorporated into these devices.

3. Dermal fillers

Dermal foot fillers may potentially be the longer-lasting solution that doesn’t require having to put products on feet or in shoes daily. There are several different fillers available, and they are actually the same ones plastic surgeons and dermatologists use on the face. The procedure is minimally invasive and can be done in-office. After the area is numbed using local anesthetic, the filler is injected around the prominent areas, thus re-creating the once lost cushion. Relief may last a couple of months up to about a year.

*Some of these over-the-counter products may contain latex.

Disclaimer: The above information is meant for educational purposes only and should not be construed as medical advice. Please consult the doctor, or your own healthcare professional, should you have questions or concerns related to your health.

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