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Fat Pad Atrophy

The Condition

The specialized fat pad at the bottom of our forefoot, which acts as a shock absorbing cushion, can begin to shrink and shift with age and use. The change in anatomy predisposes individuals to develop problems such as neuromas, metatarsalgia, capsulitis and bursitis – all of which which can make walking and standing painful and laborious. Common symptoms for patients with fat pad atrophy include forefoot pain that gets worse when standing and walking, toes that may feel as if they go numb, loss of tissue volume, and calluses that form over areas of bone prominence.

The Treatment

There are multiple conservative options available to restore the cushion at the forefoot and rejuvenate the lost tissue. Dermal fillers are injectable compounds used to “fill” or plump the areas that have lost volume. Other options may include custom-made orthotic devices used to pad and offload the forefoot. In some instances, surgery may be beneficial.

Foot cushioning fillers is a service provided by JCMG Podiatry at the JCMG Laser & Vein Center. To schedule a consultation for this service, please call JCMG Podiatry at (573) 556-7724.

Frequently Asked Questions

Who is prone to fat pad atrophy?

Everyone. Fat pad atrophy at the forefoot is a result of age, genetic predisposition, body type and physical activity. As we age the soft tissue can atrophy and shift resulting in a prominence of the metatarsal bones at the ball of the foot. Women who frequently wear high heels may have a higher incidence of this problem. Men can also develop this problem depending upon their shoe selection, occupation and other factors.

Will it cause other problems?

The atrophy of the forefoot fat pad can lead to other foot health problems. The change in anatomy predisposes individuals to develop problems such as neuromas, metatarsalgia, capsulitis and bursitis. These conditions can amplify the pain experienced and may lead to the need for additional conservative or surgical care.

Is it possible to avoid atrophy of my fat pad?

Both men and women should select comfortable shoes that fit well. Shoes that provide support, shock absorption and cushion can help to limit trauma to the forefoot and the fat pad.

What is a dermal filler?

Dermal fillers are injectable compounds used to “fill” or plump areas of the face that have lost volume. What was once ‘solely’ intended to refresh the face is now being used in the foot and ankle. There are many FDA approved fillers on the market today. Several specific products are currently used at JCMG Podiatry.

How are dermal filers used in the foot?

Dermal fillers have been adapted to reverse the effects of fat atrophy in the feet, providing patients with a virtual ‘foot facelift’. Injectable filler material can be used to cushion corns and calluses secondary to bunion and hammertoe development. They can also be utilized to provide a more youthful appearance to areas of the foot that sink with age.

What does the procedure entail?

The injection process is simple and is performed as a 15-20 minute in-office procedure. It is relatively inexpensive and painless. The affected areas are identified and the filler is injected to provide a cushion where volume loss has occurred. An immediate improvement can be observed following the procedure. Recovery is simple and only requires 24-48 hours of rest.

How long do the injections last?

The filler is broken down over time and is absorbed by the body naturally. The filler can last for up to one year or longer depending upon the injection location, patient body weight, and activity level.

Is surgery an option for this problem?

If conservative treatment options fail to completely relieve the pain, surgery may be indicated. The surgical procedure restores the balance along the metatarsal heads to alleviate the excess pressure at the ball of the foot. This is achieved via cutting the offending metatarsal, shifting it into a corrected position and securing the bone with fixation. Other options on the horizon include autogenous fat transfers to permanently replace the lost fat pad volume.

Articles

Footloose & Fancy Free: Cosmetic Treatments For The Foot & AnkleIn this article for HER Magazine, Dr. J.P. McAleer discusses solutions for unsightly nails, dermal fillers for the feet, Botox for sweat gland dysfunction, bunion and hammertoe surgery, and general foot tips.