Pain Management of Plantar Fat Pad Atrophy – A Strategic Orthopaedic Approach

Image Credit: North Bristol NHS Trust 

Authors: Gordon Slater| Tandose Sambo 

 “Health is a state of complete harmony of the body, mind and spirit. When one is free from physical disabilities and mental distractions, the gates of the soul open.” – B.K.S. Lyengar

Fat grafting is a regenerative treatment that is utilised to combat degenerative conditions induced by age, or underlying health conditions such as diabetic neuropathy. Atrophy of the fat pads that are located at the base of the foot can cause considerable amounts of pain to the patient. While countermeasures such as custom orthotics can improve the patient’s comfort, there are alternate treatments that can result in longer lasting results. A treatment plan that covers all aspects of the patient’s healthcare will often will implemented.

What Is The Pedal Fat Pad? 

The mechanical design of the feet is actually quite complex, and each of the parts of the feet have their significant functions to perform. The pedal fat is the connective tissue that runs under the ball and heel of the feet. The pedal fat pad cushions the feet, and enables mobility to be a comfortable one for the individual. With the cushioning provided by the pedal fat, forces of friction, pressure and gravity are actually minimized during the activity of motion. 

Pedal Fat Pad Atrophy therefore is the gradual degradation of the fat pad in the ball or heel of the foot. There are a variety of factors that are involved in the degradation of the fat pad, but for the most part aging is one of the influences of the onset of the condition. As a painful foot condition, the resultant thinning of the fat pad is what causes the patients to experience discomfort as the delicate connective tissue elements are exposed to higher external pressures. Internal inflammation and micro-injury is a result of the downstream effects of the pedal fat atrophy. 

With the degeneration of the heel fat pad over time, the patient’s productivity is ultimately impacted. The normal, healthy fat pad is up to 2 cm in thickness. Below the 1 cm thickness, the patient experiences the discomfort that is associated with fat pad atrophy. Patients often feel as if they are almost walking on bone. Diabetics are often mostly affected by this condition, since it is often associated with the formation of foot ulcers. 

Along with the atrophy of the plantar (sole) fat, there are downstream conditions such as rheumatoid arthritis, scleroderma and lupus. These conditions all have an impact on the tissues of the feet, and with the presence of conditions such as diabetic neuropathy, the fact that patients can’t feel pain will also induce the generation of ulcers. From a lifestyle perspective, the onset of obesity, as well as the use of high-heeled shoes in women, will increase the risk of plantar foot pad atrophy. 

How Is Plantar Fat Pad Atrophy Diagnosed? 

The best way to identify if you have plantar fat pad atrophy, is via a consultation with your Orthopaedic specialist. Your specialist will have a variety of imaging and testing tools that will enable him to fully assess the current condition of the feet. Utilizing technologies such as magnetic resonance imaging and ultrasounds, the internal condition of the feet can be visualized and assessed. With a full collation of all your personal data inclusive of the physical examination, the appropriate diagnosis can be performed. Your orthopaedic specialist will be able to feel the thickness of your fat pads via inspection. The bones can often be felt through the skin upon inspection. 

Treatment of Fat Pad Atrophy:

With all conditions, it is possible to have treatments that are either non-surgical or surgical in nature. For those with pedal fat atrophy, patients should make an effort to avoid excessive pressures on the feet. Since lifestyle conditions do contribute to the generation of pedal fat atrophy, it will be important to ensure that shoes are actually comfortable to wear. Minimize or eliminate the wearing of heels, if you have this condition. With exercises, take the time to engage in low impact activities that will optimize healing.

ith footwear, you can wear insoles that will provide cushioning for the feet. By minimizing the pressures on the feet, you will be able to protect the feet if your pedal fat atrophy is acute. 

The utilization of Regenerative Medicinal efforts to create an environment that enables the restoration of healing of the body. The utilization of platelet rich plasma injections, which have shown great benefits in the treatment of osteoarthritis, is showing great promise in the treatment of pedal fat pad atrophy.

Conservative Treatment

With conservative methods involving treatments such as custom molded foot orthoses with padding, there are some conservative treatments that have proven to be effective in the treatment of pedal fat atrophy. They are countermeasures that are quite effective in the treatment of the patient. Essentially, they ease pain and prevent symptoms from worsening. With pressure relief available, the normal function of the foot can be restored.

The aim with the utilization of these foot orthoses, is to ensure that they have a cushion of 3-5 mm. A checklist of critical items to include in the treatment arsenal include: 

*Viscoelastic Orthotic Devices 

*Heel Cushions

*Heel Cups 

*Inclusion of a cushioned top cover on shoes. Seek shoes with materials made of polyethylene foam. 

Dermal injections are also currently being utilized in order to restore the internal cushion of the foot. Materials inclusive of poly-L-lactic acid and hyaluronic acid have been incorporated into the treatment of pedal fat pad atrophy. This methodology is still being investigated and is yet to be approved by the FDA. 

.Autologous Fat Grafting

Autologous fat grafting is an emerging technology that is being used to treat pedal fat pad atrophy. This process involves a fat transfer from other parts of the body, and injecting those fat extractions into the bottom of the feet. The grafting process began approximately three decades ago, but with all technologies, there’s a curve that is involved in the understanding of the best approaches to utilize in patients in order to achieve results. With time, limitations of the technology were overcome. 

Successful transfer of fats harvested from the abdomen of patients has proven to be successful in the restoration of patient pedal fat pads that were affected by previous injuries. With a thickening of the heel fat pad, the restoration of the plantar sole was achieved. The patients were able to resume normal weight bearing capability. This discovery among others has proven to be effective in the treatment of various pedal fat pad atrophy conditions. 

While not fully effective in all patients, the procedure of fat grafting is a proven technology for the treatment of pedal fat pad atrophy. As a technique that improves the patients quality of life, the procedure is a minimally invasive procedure that treats fat pad atrophy. 

References: 

  1. Lower Extremity Review: https://lermagazine.com/article/management-of-painful-plantar-fat-pad-atrophy

Like this article?

Share on facebook
Share on Facebook
Share on twitter
Share on Twitter
Share on linkedin
Share on Linkdin
Share on pinterest
Share on Pinterest

Dr. Gordon Slater

Dr. Slater is one of the first foot and ankle surgeons in Australia to adopt minimally invasive surgical techniques. He routinely uses MIS to treat a range of conditions, including bunions.

Leave a comment

Dr Gordon Slater is a highly-skilled surgeon specialising in foot and ankle conditions and sports injuries. Dr Slater is one of the first foot and ankle surgeons in Australia to adopt minimally invasive surgical techniques. He routinely uses MIS to treat a range of conditions, including bunions. MIS  has many advantages including shorter operating times, reduced post-operative pain, reduced risk of infection, minimal scarring and better cosmetic outcomes.

Copyright © 2021 orthopaedic-surgeon.com.au