Atrophy of the fat pad on the plantar aspect of the foot is a common condition. It affects the heel or the forefoot, often referred to as the “ball” of the foot. Below, we will look at how to treat painful fat pad atrophy in the foot.
Over the past few years, the treatment modalities for fat pad atrophy have been gaining momentum in the field of foot and ankle surgery.
When walking, a pressure equal to 2.5 times your body weight can apply to your heel and front of your foot. Consequently, the fat pads necessary to cushion these areas may undergo atrophy and degenerate. Some people mistake heel pain and pain to the front of your foot for plantar fasciitis in the heel or neuroma pain in the ball of your foot.
Wearing high-heeled shoes, standing on hard surfaces for long periods, and specific activities like squats and lunges can put excessive mechanical stress and pressure on the balls of your feet. This can contribute to plantar fat pad atrophy. Another common term used to describe plantar fat pad atrophy in the front of your foot is metatarsalgia. Getting older and certain diseases can also increase the likelihood of fat pad atrophy.
The Foot and Ankle Surgeons at Foot HealthCare Associates know how to treat painful fat pad atrophy in the foot. They have helped develop and refine techniques to augment and create new fat pads and cushioning. Foot HealthCare Associates developed a non-invasive treatment called “Sole-Fill™”.
Sole-Fill Testimonial: Resolved Ball of Foot Pain 30 y/o Female
The fat pad is a thick collection of connective tissue that runs underneath the foot and heel ball.
The purpose of the pad includes:
Fat pad atrophy refers to the gradual loss of the fat pad in the ball or heel of the foot.
With this condition you experience thinning of the pad, which exposes the sensitive connective tissues to strain and pressure. As a result, inflammation and micro-tears occur.
Patients often report severe symptoms of pain and discomfort.
Other symptoms of fat pad atrophy include:
The risk of developing fat pad atrophy is relatively similar between genders.
With that said, some experts suggest that females are more susceptible to developing fat pad atrophy due to the following:
The following factors also increase the risk of fat pad atrophy:
Age: fat pad atrophy belongs to a large spectrum of diseases known as degenerative foot conditions. As you age, the production of new cartilage and fat tissues slows down, which makes the bones weaker and prone to injury.
Footwear: as mentioned above, wearing tight-fitting shoes might increase the risk of footpad atrophy. In the best-case scenario, this habit will deteriorate an already existing condition.
Injury: injuries endured after an accident are common triggers for fat pad atrophy, mainly if several surgeries are performed in the foot area.
Family history: A family history of fat pad atrophy seems to play an important role in the development of this condition.
Arthritis: the active inflammation of the joints exacerbates fat pad condition and increases the risk of their atrophy.
Diabetes: chronically elevated blood pressure increases the risk of peripheral neuropathy – a condition that precipitates pressure-induced atrophy of the fat pad.
Medications: the chronic use of corticosteroids may induce the atrophy of fat pads in adults.
Let’s take a look at the different treatment modalities for fat pad atrophy.
Experts say the mainstays of treatment for heel fat pad atrophy are custom-molded foot orthoses with padding, shoes that provide padding and support for the feet while walking, and heel cups or cushioned socks that help reduce the impact of walking on the foot.
“Conservative treatment can be quite successful; it can ease pain and prevent symptoms from worsening. The idea is to replace the fat pad with shock absorption from the outside of the foot. As a result, pressure on the foot—especially on the bones and skin, where there is often damage that seriously impacts health—can be relieved,” said John Steinberg, DPM, chief of podiatric surgery at MedStar Georgetown Hospital in Washington, DC. “Unfortunately, we often get pushback from patients who don’t want to be burdened with wearing an orthotic that they must transfer from shoe to shoe or to have to wear a shoe that looks orthopedic.”
Thus, Steinberg said, it is vital to educate patients about the importance of wearing foot orthoses throughout the day and the best ways to choose proper, sturdy, and cushioned footwear.
Kor said that patients with heel fat pad atrophy often do well with viscoelastic orthotic devices, heel cushions, and heel cups—and any material with at least 3 to 5 mm of cushion. Orthoses should also have a cushioned top cover, such as those made of closed-cell polyethylene foam.
“You want a covering that is cushioned but also does not break down over a short period,” Kor said.
In addition to these conservative treatments, interventions that involve injecting materials into the foot have been tried—with varying degrees of success. One technique is to inject silicone into the foot. However, this technique is controversial since the silicone can migrate over time. Hanna said that complications from injecting a foreign substance in the foot are also possible.
Another method some clinicians use is injecting dermal fillers into the foot. This is a procedure similar to those in which fillers are injected into the face to address wrinkles. These materials include products made with poly-L-lactic acid and hyaluronic acid. Still, they are not Food and Drug Administration-approved for use in the foot, and research into their efficacy for heel fat pad atrophy has been limited, Hanna said.
Sole-Fill Testimonial: Resolved Ball of Foot Pain 60 y/o Female
One of the newest methods for treating painful fat pad atrophy is autologous fat grafting, or lipofilling. This is a treatment in which a doctor injects fat from other anatomical sites into the bottom of the foot. Doctors have used autologous fat grafting for the foot since the 1990s. But, early scientific studies on this technique were dogged with problems, especially fat necrosis. However, recent research has documented the effectiveness of autologous fat grafting for pedal and heel fat pad atrophy.
In one study published in The Foot in 2014, a team of Italian researchers injected fat harvested from the abdomen in four patients during two sequential injections performed over 12 weeks. The four patients in the study had previously undergone repair of post-traumatic soft tissue loss of the foot with skin grafts and, in one case, a cross-leg fascia-cutaneous flap. All of the patients had pain in the plantar aspect of the foot after their surgeries, had difficulty bearing weight on the heel, and showed skin instability with recurrent ulcerations and callus formation. The heel fat pad injections aimed to thicken the tissue at the plantar sole and increase the foot’s weight-bearing capability.
According to lead author Giovanni Nicoletti, MD, a plastic and reconstructive surgeon in the clinical, surgical, diagnostic, and pediatric sciences department at the University of Pavia in Italy, all four patients demonstrated restoration of the fat pad tissue and the functional structure of the sole of the foot after the lipo filling procedure.
During recovery, doctors advised the patients to avoid dynamic and static plantar weight-bearing for two weeks. Then, 30% partial dynamic and static plantar weight-bearing was allowed, using crutches and soft socks for two weeks. In the final two weeks of recovery, the patients could engage in full dynamic and static plantar weight-bearing, wearing custom plantar insoles, custom shoes, or both.
All four patients experienced good outcomes from the surgery with no severe complications. However, clinicians should be aware of the risk of potentially serious complications associated with these procedures, including infection and fat necrosis from failed adipose tissue engraftment, Nicoletti said.
Doctors have also tried fat grafting to prevent ulceration in high-risk diabetic feet. In a case report published in Plastic and Reconstructive Surgery Global Open, David Armstrong, DPM, MD, PhD, and colleagues used fat augmentation to address plantar fat pad atrophy and recalcitrant ulcerative lesions in a patient aged 37 years with type 2 diabetes who had previously undergone tibialis anterior tendon transfer for a progressive chronic styloid ulcer. After four weeks in a splint, the patient successfully transitioned to standard shoe gear and had no complications or recurrence of his wound at six weeks, Armstrong says.
“The question we asked was: Will this grafting hold up? It appears it will, although we don’t have good long-term data yet,” said Armstrong, a professor of surgery at the University of Arizona and deputy director of the Arizona Center for Accelerated Biomedical Innovation in Tucson. “By using the fat grafting technique for heel fat pad atrophy, we give our patients with diabetes time to recover from ulcers, reduce stress on the feet, and decrease the risk of ulcers. We can heal many of our diabetic patients with ulcers by using other techniques, but the real tough nut to crack is keeping these patients healed and giving them quality of life.”
He said the procedure was a means of achieving tissue repair in addition to being a reconstructive surgery.
“Thus, we could interrupt the cycle of ulceration in the diabetic foot and keep patients with diabetes and diabetic neuropathy in remission [ulcer-free],” Armstrong said.
Do you suffer from the pain of fat pad atrophy and live in or around the following areas? Book an appointment with a doctor at Michigan Podiatry.
Footpad atrophy is a common condition that affects the ball and heel of the foot. Prompt treatment with one of the listed treatments can often provide dramatic relief and improve quality of life.
The Doctors at Foot Healthcare Associates know how to treat painful fat pad atrophy. Contact the foot doctors in Howell, MI, today.
Sole-Fill Testimonial: Resolved Ball of Foot Pain 70y/o Male
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©Copyright 2025 Foot Healthcare Associates.
