The fat pad is a thick collection of connective tissue that runs underneath the ball of the foot and the heel. The purpose of the pad is to provide cushioning to minimize the effect of pressure and friction on the foot. It also serves as a mechanical anchor to shift the body weight without overwhelming the soft tissues. As we age, the fat pad wears down and thins. We call this “atrophy.” This explains why people have more tenderness on the bottom of their feet with age. Also, you will note more callusing and corns with age, because the skin is subject to more friction and pressure without the added protection.
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Symptoms
Fat pad atrophy causes tenderness along the bottom of the heel and forefoot. Sometimes there is atrophy along the underside of the heel, but not the forefoot and vice versa. As the “cushioning” wears down, the foot bones become closer to the ground and the pressure is felt more intensely. People with fat pad atrophy complain of calluses, corns, pain with walking, especially barefoot and a “thinner”/more bony appearance to the foot.
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Causes
The following factors play a role in fat pad atrophy: -Genetics & Age -Footwear: wearing tight-fitting, or high-heeled shoes might increase the risk of atrophy. -Injury: injuries endured after an accident or surgery. -Arthritis: the active inflammation of the joints exacerbates fat pad condition and atrophy -Diabetes: chronically elevated blood sugar increases the risk of pressure-induced atrophy of the fat pad. -Medications: the chronic use of corticosteroids may induce the fat pad atrophy in adults.
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Treatment
When treating fat pad atrophy, 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. This is typically accomplished with the use of orthotics and cushioning shoes from a Canadian Certified Pedorthist. If regular cortisone injections are occurring, it is recommended to discontinue them. But you might need to contrast risk vs benefit and discuss this with your family doctor or NP. Calluses and corns can be addressed by a Footcare Nurse or Registered Chiropodist.
