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Fat Pad Atrophy

The Condition

The specialized fat pad at the weigh bearing surface of our heel and forefoot act as a shock absorbing cushion. This tissue can shrink and shift with age and use. The change in anatomy predisposes individuals to develop problems such as neuromas, metatarsalgia, capsulitis, bursitis and some forms of heel pain. These conditions can make walking and standing painful and laborious. Common symptoms for patients with fat pad atrophy include foot 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 volume at the forefoot and rejuvenate the lost tissue. Dermal fillers and injectable adipose allografts are materials used to restore tissue volume to areas of atrophy and loss. Treatment options may also include the fabrication of custom-made orthotic devices to pad and offload bone prominences. Surgery may be beneficial depending upon the cause of the fat pad atrophy and the location.

To schedule a consultation for this service, please call JCMG Podiatry at (573) 556-7724.

Frequently Asked Questions

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.

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.

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.

Leneva® is a first-of-its-kind human adipose tissue that may be used for tissue reconstruction, replacement and reinforcement of damaged or inadequate integumental adipose tissue matrix. As an all-natural extracellular adipose matrix, Leneva is a safe, natural, off-the-shelf solution that has multiple clinical applications including, but not limited to: the treatment of Diabetic Foot Ulcers, Pressure Ulcers and Tunneling Wounds. Leneva is also indicated for use in patients that have Fat Pad atrophy and volume loss. It can also be used in Fat Pad Reconstruction Procedures.

Leneva is an off-the-shelf injectable human adipose tissue that is designed to support your body’s own tissue regeneration process.

It is an extracellular matrix that functions as a scaffold for cells to create new fat which help to augment areas of loss, and in turn, increase tissue density. It has been shown to significantly increase adipocyte formation in injected hosts.

Leneva is a tissue allograft which is derived from donated human adipose (human fat).

Leneva undergoes strict processing designed to maintain the structural integrity of the tissue without sacrificing quality and sterility. This process allows for retention of key matrix proteins such as Collagen IV and Collagen VI as well as adipogenic and angiogenic factors leptin, adiponectin, FGF-2 and VEGF, while successfully removing residual lipid, cellular fragments, and DNA content.

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.

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.

The injection process is simple and is performed as a short in-office procedure. The affected areas of concern are identified and the material selected is injected to provide relief where the volume loss has occurred. An immediate improvement can be observed following the procedure in most cases. Recovery requires a short period of non-weight bearing to protect the injected material so it’s not compressed, which can extrude the material into the adjacent tissues.

The dermal filler material is broken down over time and is absorbed by the body naturally. The filler can last for up to 3 months or longer depending upon the injection location, patient body weight, and activity level.

Leneva helps to restore the lost tissue volume on a more permanent basis. However with age, fluctuation in weight, activity level and other compounding factors patients can still have additional and continued fat pad atrophy. This process may occur overtime regardless if treatment is rendered. This is a part of the aging process and can be frustrating for patients affected by this condition.

If conservative treatment options fail to relieve the pain associated with the condition, surgery may be indicated.

Surgical procedures such as the restoration of the bone position to alleviate the excess pressure at the foot can be beneficial. This is achieved via cutting the offending bone, shifting it into a corrected position and securing the bone in place with fixation.

Other options include rotational tissue flaps to reconstruct the fat pad.

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.