What is Plantar Fat Pad Atrophy? Treatment and Management
Plantar Fat Pad Atrophy is the continuous and gradual loss of fat pad in the heel or ball of the foot. This condition happens as a result of changes in the thickness or elasticity of the plantar fat pad. As one grows, the plantar fat pad that serves as a cushion to absorb shock begins to atrophy. This is usually caused by wear and tear of the muscle fibers and fatty tissues that constitute the heel pad over time; thus, leading to pains in the heel and ball of the foot that could disrupt the daily activities of individuals.
The heel fat pad can be likened to the thread of a tire that gets worn out as it is being used. Likewise, our feet, the more we use them, the more the fat pad wears out. A healthy and normal fat pad measures between 1cm to 2cm in thickness; people who have plantar fat pad atrophy have their fat pad measures less than 1cm. So, patients walking without a fat pad will have a feeling of walking on the bone.
Anatomy of the Plantar Fat Pad
The plantar fat pad or heel fat pad is a special adipose structure above the proximal and calcaneum plantar fascia which are surrounded by ligamentous chambers that serve the function of cushioning the effect of heel slip during movement. It also helps to distribute the body weight effectively without exerting excess pressure on the tissues under it
The plantar fat pad can absorb up to 200% of the body weight during running and about 110% of the body weight while walking. This excess pressure and load can lead to the thinning of the heel fat pad; thus, bringing pain to the heel and the ball of the feet.
Risk Factors and Causes of Plantar Fat Pad Atrophy
Plantar Fat Pad Atrophy or Heel Fat Pad Atrophy can happen as a result of injury, strain, or overuse of the corpus adiposum. The two most significant factors responsible for Plantar Fat Pad Atrophy or Heel Fat Pad Atrophy are the gait or biomechanics, and the alignment of the arch of the foot. If the arch of the foot that supports the foot in the proper alignment of the body is compromised or injured, it exerts extra pressure on the fat pad.
Here are some of the causes of plantar fat pad atrophy
1. Inflammation of the Corpus Adiposum: Inflammation of the plantar fat pad happens when force or pressure is continually exerted on it for a prolonged time or repeatedly. This is common among individuals that are involved in high-impact sports that require them to always jump; sports include gymnastics, basketball, volleyball, high jump, long jump, etc.
2. Force: Running or walking barefoot on hard surfaces like tiles or concrete can exert unnecessary force on the fat pad; thus, causing the fat pad to get thin and strenuous on the corpus adiposum and bruising the calcaneus.
3. Obesity and Overweight: Individuals that are obese or overweight are at higher risk of having plantar fat pad atrophy since their excess body weight puts more pressure on the fat pad.
4. Gait Imbalance: Individuals with feet pointing outwards or inwards can suffer from plantar fat pad atrophy; since their heel is hitting the floor in a defective way when they run or walk. The corpus adiposum becomes thin, inflamed, or worn in the area where the heel is touching the floor vigorously.
5. Plantar Fasciitis: When the plantar fascia is inflamed or injured, the ability to maintain and distribute balance and force while walking or running is lost; such that it adds excess pressure on the fat pad, and consequently leading to wearing and tearing of the corpus adiposum.
6. Underlying Medical Conditions: Although, it is not common; some medical conditions can cause Plantar Fat Pad Atrophy. These medical conditions include rheumatoid arthritis, lupus, and type 2 diabetes.
7. Age: Plantar Fat Pad Atrophy belongs to the category of degenerative diseases. Where, as you grow older, the formation and production of fat tissues and new cartilage slows down; thus, making the bones and fat pad weak and prone to injury.
8. Footwear: Tight-fitting shoes may increase the risk of footpad atrophy, as it exerts unnecessary pressure on the toes. In most cases, footwear only deteriorates an existing condition.
9. Genetics or Family History: Having a family member with Plantar Fat Pad Atrophy can increase the risk.
10. Corticosteroid Injections: Plantar Fat Pad Atrophy could be a side effect of corticosteroid injections given to an individual as a result of inflammation and pain treatment for other foot conditions.
11. High Arch: Individuals with high arched feet are more at risk to develop Plantar Fat Pad Atrophy, especially if they are runners.
Prevention of Plantar Fat Pad Atrophy
Although some factors that cause Plantar Fat Pad Atrophy cannot be prevented; however, Plantar Fat Pad Atrophy can be prevented taking these measures:
- Maintain a healthy weight
- Wear proper footwear that has enough cushion
- When performing high-impact sport, wear an athletic shoe
- Try avoiding heel shoes, especially the pointed ones
- Change your shoe regularly when needed
- Avoid walking barefoot on hard surfaces
(first signs, and then prevention)
Signs and Symptoms of Plantar Fat Pad Atrophy
Symptoms of Plantar Fat Pad Atrophy may include:
- Pain is greater when standing and reduced when seated
- Pain is often felt as if there was an injury on the heel pad when pressing the heel while running, running, or walking for a long time
- The pain is increased while standing or walking, especially if one is doing these things barefoot.
- Pain is usually experienced on one side of the feet. I.e. it happens to one heel and not both.
- Deep aching pain in the center of the heel.
Diagnosis of Plantar Fat Pad Atrophy
Diagnosis of Plantar Fat Pad Atrophy can be made on assumptions and physical examination by the doctor. An ultrasound test or X-ray of the foot will be performed to ascertain the right condition and rule out other ones.
Furthermore, the thickness of the fat pad will be measured. A normal fat pad thickness should be between 1cm to 2cm; anything less than 1cm is considered atrophied. To check for Plantar Fat Pad Atrophy, the therapist will compare the fat pad by checking the thickness when it carries a big weight and when it does not. The result will determine the doctor’s assumption.
Treatment and Management of Plantar Fat Pad Atrophy
Plantar Fat Pad Atrophy can be managed and treated in the following ways.
The conservative treatment aims at managing the symptoms by reducing the inflammation and pain; thereby improving the quality of the patient’s feet. With this approach, the fatty tissues left in the fat pad are preserved and protected from further damage. This method decreases inflammation, which makes the fat pad heal on its own. Conservative treatments include:
Rest: Take a break from your daily activities and minimize your walking or standing time. Also, avoid high-impact activity.
Icing: Icing the fat pad can reduce the pain caused by your fat pad. You can get an ice pack in a bottle or buy Ice Therapy Slippers.
Exercise: Do a physical exercise that rehabilitates the joints and muscles of the ankles, upper and lower legs, and feet.
Medication: Over-the-counter anti-inflammatory and pain relief medications like ibuprofen and Voltaren can help reduce the fat pad pain
Usage of Heel Cups and Orthotics: Get a good shoe insert and heel cup that has sufficient cushions to help distribute the body weight and relieve pressure on the ball of the feet.
If after trying the conservative treatments method, the fat pad fails to improve and the pain remains the same; you should visit a doctor. A more advanced solution would be suggested to you after a thorough examination. The suggestions would be based on the severity of the case. The solution provided by advanced treatment aims at replacing the thinning heel fat pad to provide a faster result and prevent more damage. The different heel fat pad replacement includes;
These are materials known as dermal fillers, used to thicken the displaced fat pad in the plantar fascia and heel. Dermal fillers are either natural or synthetic materials injected into the skin to increase the volume of that area. This is the most common treatment with minimal side effects. The recovery is seen almost immediately, as patients can start walking immediately using recommended footwear and avoiding high-impact activities. The results can last up to 2 years depending on the age of the person, weight, lifestyle, and the materials used.
This is also known as autologous fat transplantation or fat grafting. It involves taking fatty tissues from one part of the body and putting it in another part. In this case, fatty tissues are taken from any part of the body and placed in the heel. The fat is usually taken from a location with plenty of fat like the thigh or abdomen even if only a small amount of fat is needed for this treatment. This procedure is easy and fast to perform and the recovery time is 3 weeks and the results last longer than the injectable dermal fillers.
This is the augmentation of the plantar fat pad by using fat gotten from another person. Fat grafts do not have any living cells, which means the receiver’s body will not react to it negatively. This treatment is complicated and requires surgery to get it done. Recovery is longer and usually lasts up to 8 weeks. The results are reliable and can last for 5 years.
Nobody wants to deal with plantar fat pad atrophy. Apart from the pain, it keeps you off your feet and from your daily activities. If you feel pain in your heel, it is important you visit your doctor for proper diagnosis and treatment suggestions.