Fat Pad Atrophy: Symptoms, Causes, Tests, and Treatments

Are you experiencing deep heel pain that worsens with activity? Fat pad atrophy, the second leading cause of heel pain after plantar fasciitis, could be the culprit. With the heel absorbing up to 200% of body weight during running, it's no wonder the heel pad can break down over time. Less commonly, this condition can also affect the balls of your feet.

The breakdown of fat tissue leads to a lack of natural shock absorption and closer proximity of the foot bones to the floor, causing reduced protection and foot pain.

Fat Pad Atrophy Symptoms

Symptoms of fat pad atrophy include:

• Deep, dull pain in the heel or ball of the foot
• Increased pain when pressing on the middle of the heel
• Burning sensation in the heel or ball of the foot that worsens with activity
• A sensation of being able to feel your heel or foot bones
• Pain that intensifies with prolonged walking or standing, especially on hard surfaces
• A knocking sound instead of a soft tap when walking barefoot on hard surfaces
• Pain that occurs more often at night or when resting, often affecting both feet (unlike plantar fasciitis, which is usually worse in the morning and more likely to affect one foot)

Fat Pad Atrophy Causes

The causes of fat pad atrophy may include:

• High-impact, repetitive activities
• Advanced age
• Genetic predisposition, such as a gait abnormality that causes uneven wearing of the fat pads
• Conditions like diabetic neuropathy, which frequently affects the feet
• Plantar fasciitis, leading to increased pressure on fat pads due to reduced force distribution during walking or running
• Prolonged standing and walking
• Surgery, fractures, or other foot trauma
• Improper or no footwear
• Being overweight or obese

Fat Pad Atrophy Diagnostic Tests

During a physical exam, your doctor will press on the center of your heel to check for pain. The thickness of your heel pad will also be compared when standing and when not bearing weight. Healthy heel pads are typically 1-2 cm thick, while atrophied fat pads are less than 1 cm. Your doctor may order an X-ray or diagnostic ultrasound to rule out other causes of pain.

» Suffering from diabetic neuropathy? Find the best insoles for your condition

Fat Pad Atrophy Treatment Options

As it's a very common condition, many doctors often hear the question,"Can fat pad atrophy be reversed?" Sadly, no, fat pad atrophy cannot be reversed. But it can be treated very effectively.

Treatment for fat pad atrophy depends on the severity of the condition. Conservative and at-home care, such as rest, icing, and over-the-counter medication, can often help relieve pain and reduce inflammation. Taping the heel or foot to reposition structures and provide more cushioning for the foot bones can also help alleviate pain.

Other conservative approaches include cushioned socks and shoe inserts for extra cushioning and pain relief. When selecting shoe inserts, opt for ones with a deep heel cup.

If conservative treatments are insufficient, your doctor may recommend dermal filler injections to restore tissue volume in areas of atrophy and loss. In severe cases, surgery may be necessary, such as fat grafting, transplantation, or procedures to correct foot deformities and improve weight distribution.

Cushion Your Feet

Despite the pain and loss of function caused by fat pad atrophy, numerous treatment options are available for effective management. Insoles, for instance, offer cushioning and shock absorption that your foot may lack. They also help redistribute your body weight more evenly, reducing the repetitive forces from walking and running that can contribute to fat pad atrophy. Check out Footora's blog and explore the best insoles designed to help with fat pad atrophy.