Have you been experiencing discomfort in the balls of your feet? You may have plantar fat pad atrophy, which is the breakdown or thinning of the protective fatty cushion, located underneath the heads of the metatarsal bones in the ball of the foot. This fat pad is there to cushion the load of our body as we walk or stand. Its absence, whether partial or complete, leads to pain in the ball of the foot when we move or stand, and may adversely affect our gait, (how we walk).
Why do we need a fat pad in
the ball of the foot?
When we walk, we bend our foot, pushing ourselves forward with the help of our toes and the ball of the foot. For an instant, the whole body weight shifts onto these tiny bones. To absorb this load therefore, is the cushion of fat located beneath the heads of the metatarsal bones as stated above, where they unite with the toes.
The plantar fat pad is actually formed by the union of five individual metatarsal fat pads. It acts as a cushion that absorbs the shock and disperses the force, protecting the bones and the soft tissues of the ball of the foot. Likewise, there is a fat pad in the heel area, since when we stand or walk, the body weight is transferred through the heels and ball of the foot, so both these areas need protection.
Any condition that destroys or displaces this protective layer of fat, leaves the metatarsal heads devoid of a shock absorber. As well, it leads to a transfer of the body loads directly to the underlying soft tissues, causing their irritation, along with eventual inflammation and pain. In addition to the pain, there may be callus formation and even ulceration.
What causes it?
• Ageing is considered the most important cause. With increasing age, this supporting adipose (fatty) tissue in the sole of our foot is reduced, the same way the adipose tissue is reduced in the rest of the body.
• There may be variances in the degree of plantar fat pad loss with ageing among individuals, and genetics are strongly considered to be the cause behind excessive fat pad loss.
• A downward displaced metatarsal head will crush the fatty tissue located underneath.
• In rheumatoid arthritis, the severe contracture of the toes leads to forward displacement of the fat pad.
• Persons with high arched feet could also be affected by the severe contracture of the toes, leading to forward displacement of the fat pad.
• In neuropathic diabetic patients with toe deformity, there is often thinning and forward displacement of the metatarsal fat pad, which increases their risk of developing foot ulcers.
• Neuroma treatment can put you at risk for damage to the plantar fat pad,
and is a common problem when surgical removal of the nerve is performed. There is also a case report where steroids injected into the area for the treatment of Morton’s neuroma, led to plantar fat pad atrophy.
• Multiple surgical incisions or fractures, may also lead to thinning or shifting of the plantar fat pad.
• Wearing high-heeled shoes, walking barefoot, or in very thin soles, may initiate or worsen the condition.
Symptoms of this condition are:
• Pain and tenderness in the area.
• Difficulty when you attempt to walking barefoot.
• Callus formation or even
ulceration in some cases.
• Callus formation.
• Prominence of the metatarsal heads due to loss or shift of the fatty covering.
The treatment plan for you may involve:
• Weight-loss if this is a factor in the development of the syndrome
• Anti-inflammatory medication
• Activity modification to avoid high impact and hard surfaces
• Padding and strapping techniques
• Footwear advice
• Heel padding
• Orthotics to cushion and redistribute weight evenly across the foot and provide shock absorption.
The metatarsal pads or arch supports help to reduce the pain as the area is cushioned, thus dispersing the force and reducing pressure on the vulnerable tissues. Orthotics cushion the heads of the metatarsal bones, leading to less pressure and callus formation.
Although plantar fat pad atrophy affects both men and women equally, the choice of footwear makes women more vulnerable to developing pain and calluses in the ball of the foot. You’re strongly advised to avoid the risk factors, by wearing shoes that provide adequate cushioning to weight-bearing areas of your foot, to help solve the problem.
Your feet mirror your general health . . . cherish them!