No Fat on the Bottom of Your Feet? What You Need to Know About Fat Pad Atrophy

Do your feet feel painful after you walk on a hard surface without shoes? Are high-heels completely out of the question due to intense pain? Do you always seem to have calluses, regardless of how many pedicures you get? If so, you might have fat pad atrophy.


Losing fat is often the topic of conversation on health blogs for reasons like improved health, better cardiovascular fitness, boosted confidence, and more. But in the case of fat pad atrophy in the feet, that isn’t the case. In fact, when you lose the fat on your feet, you are faced with persistent pain that can prevent you from living a happy and fulfilling life.


Today we’re going to do a deep dive into fat pad atrophy. What is fat pad atrophy? Why is there fat on the bottom of your feet? What are the symptoms and causes of this condition? And finally, what you can do about it.


What is fat pad atrophy?

Bottom of feet

Fat pad atrophy is the gradual loss of the fat pad in the ball or heel of the foot. This thinning of the fat exposes the sensitive connective tissues to strain and pressure. It’s essential to have fat pads on the feet, because these act as cushioning to soften the impact of your feet hitting the ground every day.


During a typical day, your feet bear the collective load of hundreds of thousands of pounds. On average, your feet absorb a total force of 26,000 pounds. Wearing high heels or doing high-impact exercise like running drastically increases the total amount of force your feet absorb.


The fat pad in the foot is a thick layer that lies on the plantar surface, cushioning the forefoot and heel when it makes contact with the ground. This function is necessary, helping to shield the feet from damage and repeated stress.


When plantar fat pad atrophy occurs, it can be devastating. Inflammation and micro-tears occur. This leads to intense pain and confusion, as oftentimes, the source of the pain isn’t clear. Severe atrophy can prevent you from walking or standing on your feet for long periods of time, because the impact is taking its toll.


Fat pad atrophy is often associated with heel pad syndrome. This is a pain that occurs in the center of the heel, but is due to fat pad atrophy. Heel pad syndrome can present alongside plantar fasciitis.


What does fat pad atrophy feel like?


● Pain under the heel or ball of the foot

● Difficulty walking on a hard surface without shoes

● A burning sensation

● Dull ache

● A sensation that you are stepping on pebbles


Foot pain

What are other symptoms of fat pad atrophy?


Aside from the aforementioned symptoms associated with pain, fat pad atrophy is linked to other symptoms. For example, if you have chronic calluses on your feet, it may be indicative that the fat is thinning. In the case of heel pad syndrome, if you have been diagnosed with plantar fasciitis, this can be connected to fat pad atrophy.


Many people with this condition have reported a feeling that they are walking “directly on the bone” and even hearing the bone make contact with the ground with each step. As unpleasant as this sounds, it’s a tell-tale indicator of fat pad atrophy.


You may be asymptomatic. You may only consider there to be an issue after performing high-impact exercise or standing on your feet for an extended period of time. If this sensation occurs, don’t ignore it, to prevent it from getting worse.

What are the risk factors for fat pad atrophy?


● Obesity - The increased load from excess body weight can cause the fat pad to lose its protective resiliency.

● Plantar fasciitis - Studies show that having plantar fasciitis is linked to a thinner metatarsal fat pad.

● Rheumatoid arthritis (RA) - RA is associated with atrophy of the muscles, cartilage, bones and fat tissue, caused by inflammation. This happens all around the body, and the feet are no different.

● High-impact exercise - High-impact exercise like running or jumping can cause the thinning of fat pads over time. This aggravates the foot, and can exacerbate the loss.

● Wearing high-heels - Wearing high-heels shifts your weight to the front of your weight, placing excessive mechanical stress and pressure on the balls of your feet. In general, wearing poorly cushioned shoes can also exacerbate this condition.


How to treat fat pad atrophy


The first point-of-call is to meet with a podiatrist to get the condition diagnosed. If fat pad atrophy is severe, it will require medical intervention to treat it most effectively.


If you want to try and treat this condition yourself, the first thing you need to do is to replace the fat pad with shock absorption from the outside of the foot. In short, wear better shoes. Look for shoes with added cushioning. This will give your feet the support they need so the wearing down of the pads starts to halt. This may give your feet the chance to repair themselves naturally, rebuilding the fat tissue that has been lost.


Wearing orthotics or shoe inserts is a go-to treatment for many podiatrists. As stated by John Steinberg, DPM, chief of podiatric surgery at Medstar Georgetown Hospital in Washington, DC. “Conservative treatment can be quite successful; it can ease pain and prevent symptoms from getting worse.” Simply getting insoles for your shoes that you wear on a daily basis can help to give your feet a break, to repair. Click here to shop for custom insoles.


Steinberg can be quoted again to say, “Patients with heel fat pad atrophy often do well with viscoelastic orthotic devices, heel cushions, and heel cups—and any material that has at least 3 to 5 mm of cushion.” The goal is to give your feet what they are lacking - cushioning! They

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In severe cases, you may have to treat fat pad atrophy with fat grafting. While it is effective, most patients prefer to use this as a last resort.

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