Foot Fat Pad Atrophy & Augmentation: Causes & Best Treatment 2019

Foot Fat Pad Atrophy and Augmentation – If the foot fat pad degenerates, 95% of the time your pain is due to the bones not being cushioned enough!


Foot Fat Pad Atrophy and Augmentation – If the foot fat pad degenerates, you will need to try and cushion it to relieve the gradual aching pain!


Plantar Fat Pad Atrophy Overview:


  • Between the heel bone and the skin at the bottom of the feet is a thick layer of cushioning fat.
  • There is also a fat pad in the ball of your feet.
  • Fat pads in these two regions are necessary to cushion your heel strikes and push off.
  • It is possible for this fat pad to degenerate over time and due to age and overuse.
  • Normally they are 1 inch thick in the heel, but get much thinner over time.
  • It will feel like you are walking on bone.
  • There are numerous treatment options such as using shoes and cushions conservatively.
  • Surgical options include fat pad augmentation surgery to restore cushion to your heel.
  • Also known as Foot Fat Pad Syndrome.


Ball of the foot plantar fat pad atrophy
This is an example of ball of ball of the foot plantar fat pad atrophy. The best way to take pressure off of this site is too use a good supportive pair of orthotics for the ball of the foot!


Symptoms of Plantar Fat Pad Atrophy:


  • Pain under the heel while walking barefoot on a hard surface.
  • Pain under the metatarsal heads when walking on a hard surface.
  • It feels like a dull ache in the center of the heel.
  • It is possible to feel the heel bone with your fingers through the fat pad.
  • If it feels like hardly any cushion, atrophy is more likely than fasciitis.
  • The pain in your heel is worse the more you walk on it.
  • If the pain is worse in the morning and before activity, consider plantar fasciitis.
  • A loud knocking noise as you walk barefoot on a hard surface.

Causes Of Plantar Fat Pad Atrophy:


  • This can occur normally due to the aging process.
  • Chronic stress over the fat pad can also cause it to shift of degenerate.
  • This is most common in high arched people.
  • High arches put more stress on the heel and the forefoot.
  • The fat pad in the ball of the foot slides forward and does not protect the bone.
  • A history of corticosteroid injections is also possible.
  • Acute injury.
  • Diabetes.
  • Smoking.


Heel fat pad cushion atrophy and heel spur formation
This is an example of heel fat pad atrophy. There is a lack of cushion on the bottom of the heel and this spur is pushing against the ground. This can cause a large amount of heel pain while walking!


Fat Pad Atrophy in the Ball of the Foot:

  • Same problem as in the heel, but it is present in the ball of the foot
  • The metatarsal heads do not get enough cushion.
  • This is felt the most during push-off.


Ball of the foot plantar fat pad atrophy
This is an example of ball of ball of the foot plantar fat pad atrophy. The best way to take pressure off of this site is too use a good supportive pair of orthotics for the ball of the foot!


Plantar fasciitis verse heel pad atrophy:


  • Atrophy of the heel pad is actually less common than you think.
  • Many patients that we see believe that they are having heel pain because of the atrophy of their steel fat pad.
  • The reason over 90% of people have heel pain, is not due to heel fat pad loss. This is due to a condition known as plantar fasciitis.
  • To make your life easier, and to make sure that you don’t pursue a very difficult and fruitless treatment, simply consider that your heel pain is very very likely plantar fasciitis, unless you and your podiatrist can prove otherwise with imaging.
  • Plantar fasciitis is a condition we see 10 times a day or more, and almost everybody thinks that this heel pain is due to pressure and compression against their heel. This is not the case. This is simply where your plantar fascia inserts into the heel, and as it starts to pull out of your bone, and strain, this causes severe pain.
  • Click on this link to follow to our plantar fasciitis treatment guide.


Plantar fasciitis verse heel fat pad atrophy
Plantar fasciitis is horizontal strain of the plantar fascia ligament. Fat fad heel atrophy is the loss of fatty tissue on the heel. Most people under 75 years old have plantar fasciitis, as you get older it is possible to get heel pad atrophy.

Foot Fat Pad Contusion:


  • A heel fat pad contusion is known as a heel bruise.
  • It is also known as a stone bruise.
  • This is named after the most common cause, stepping on a stone!


Jump To Our Heel Bruise Or Stone Bruise Guide.


Plantar Fat Pad Treatment:


Plantar Fat Pad Taping:

  • Icing and fat pad taping is possible.
  • But this is not an inflammatory condition.
  • This is also not a biomechanical condition that requires taping.
  • The fat pad taping would most likely only have a placebo effect.


Foot Fat Pad Conservative Treatment:

  • Avoid treating this condition like plantar fasciitis.
  • This is a non-inflammatory condition like plantar fasciitis.
  • It gets worse with increased weight bearing, whereas plantar fasciitis gets better with movement.
  • Plantar fasciitis is helped by wearing rigid orthotics that help control overpronation;  fat pad atrophy requires cushioned gel insoles and heel pads.
  • The best thing to do conservatively is to get some well cushioned running shoes.
  • Add gel heel inserts or full length gel insoles into those shoes.
  • See a Podiatrist to rule out heel bursitis.


Procedures For Restoring the Plantar Fat Pad:


  • There are many different surgical treatments for atrophy of the plantar fat pad. These are gaining momentum, and some of the treatments are worthwhile.
  • Some people have historically believed that these were cosmetic treatments, but we definitively know firsthand that this can cause severe pain as you are standing and walking for long periods of time.
  • This type of surgery is known as restoring your cushioning, providing a filler, and restoration of fat pad treatments. These types of treatments are considered newer, and unfortunately are not covered by insurance as it is currently described.
  • Here we will go over the types of treatments that are available:
  • Changing your shoes and patting your feet is definitely annoying but there is no doubt that this is by far the most effective treatment.
  • It’s amazing how many times people have come in doubting that orthotics or shoes will work for them, only to come back a couple weeks later saying that 100% of their foot pain has essentially gone away. You have to trust your experience in this case, this works almost every single time!
  • If for some reason you have to wear high heels or a very impressive looking shoe for work, this is where you can start looking for other options.


Plantar fat pad surgical options:

  • There are three main options to augmentation of the plantar fat pad:
  • These three options are injections, the second option is the use of a foreign substance called in allograft, the last is transplanting fat from one part of your body into your feet.


Injectable fillers for foot fat pad:

These have used for many decades, unfortunately this is not necessarily considered proven treatment and are considered off label. There are some offices that do this is a cash pay, but this is not something that’s is covered by insurance. There is less overall downtime to this, and they can probably done in the office, but at the same time it is not the most studied or proven thing even though some people do swear by it.



Foot Fat Pad Augmentation Surgery:

  • A small incision is made and the tissue matrix is packed in.
  • This can be done in the heel.
  • It can also be done in the ball of the foot.
  • The goal of this tissue matrix is to create a spongy scaffold that your body will incorporate.
  • This will become your new “foot fat pad”.
  • The procedure could have you back on your feet within 2-3 weeks.
  • This is an effective procedure and the thickness of the fat pad is increased.
  • Studies show no risk beyond the usual risks of undergoing surgery with no evidence of graft rejection.



Allograft for foot fat pad:

This is generally a graft matrix sheet. This is the surgical process where an incision is made on the bottom of your foot in the graft is installed. Once more some people do swear by this, but you are looking at about 6 to 8 weeks of recovery time, without necessarily guaranteed or proven results. This is considered more experimental surgery, and it is generally not something covered by insurance.


Transplantation of your own fatty tissue:

  • This is something called autolipotransplantation, talk about this is a procedure where you harvest fatty tissue from one site, usually your thigh or your abdomen, and that it is transplanting the bottom of your foot.
  • Some plastic surgeons have been known to perform this procedure, but again the research is important was considered more of an experimental procedure.



Foot Fat Pad Augmentation:

  • This is a surgical procedure which attempts to implant a “substitute” tissue.
  • The ideal tissue substitute would not interact with your body, but would cushion the atrophied area.
  • The most common material used is graft jacket.
  • Biotape is also possibility.
  • These are both tissue matrices.
  • Think of them as a scaffold that allows fat pad and healthy tissue to grow into.
  • This is similar to a sponge, that is eventually filled in.
  • These grafts are acellular, meaning little chance of graft rejection.


Graft Jacket Fat Pad Augmentation:

  • Graft Jacket is a human dermal collagen template that is readily incorporated into the body.
  • The matrix a process that renders that material essentially acellular.
  • It is freeze dried with a process that prevents the formation of ice crystals to preserve the intact matrix including vascular channels.
  • Graft Jacket Matrix contains collagen, elastin, hyualuronan, fibronectin and proteoglycans.
  • For click here more on this type of treatment


Good Luck with your Foot Fat Pad Atrophy and Augmentation!