By Dr. Lori DeBlasi, DPM, FACFAS
As a podiatrist, I often view the human body through the lens of the feet. They are our foundation, yet they are often the last place
As we age, our bodies undergo many changes, but one of the most significant—yet often overlooked—occurs right beneath our feet. Fat pad atrophy is the medical term for the thinning and shifting of the natural cushioning on the bottom of the feet. This occurs because the collagen and elastic fibers that give our foot pads their “bounce” naturally degrade over time.
Most commonly affecting the heel and the ball of the foot (the metatarsal area), this condition can make simple daily activities feel like a trial. Patients often describe the sensation as “walking on pebbles” or “walking directly on bone,” sometimes accompanied by a persistent burning sensation.
The Impact of Lost Cushioning
The fat pads serve as the body’s built-in shock absorbers, protecting the heel bone and metatarsal heads. When this padding thins:
• Pressure Lesions: Without protection, the underlying bone creates excessive pressure against the skin, often resulting in painful calluses.
• Heightened Sensitivity: Symptoms are typically worse when walking barefoot or during prolonged periods of standing.
• Secondary Issues: While not a direct cause, fat pad loss can exacerbate the symptoms of a neuroma (a pinched nerve), as there is less buffer between the nerve and the ground.
The High-Heel Factor
For women, footwear choices can significantly impact comfort. Wearing a heel greater than one inch shifts the majority of body weight onto the ball of the foot. With the loss of natural padding, this extra pressure on the metatarsal heads quickly leads to inflammation and lesion formation.
Managing the Discomfort: 5 Key Strategies
While fat pad atrophy is a natural part of aging and is not reversible, you can successfully manage the symptoms with these practical adjustments:
1. Stop Barefoot Walking: Always provide an artificial layer of protection between your feet and hard surfaces.
2. Use External Cushioning: Look for gel metatarsal cushions, gel heel cups, or full-length neoprene inserts. Note: Despite marketing claims, memory foam is often too soft to provide the structural support needed to replace lost fat pads.
3. Lower Your Heels: Stick to shoes with a heel height of one inch or less to keep weight distributed evenly across the foot.
4. Modify Your Activity: High-impact activities like running or jogging put immense force on the forefoot. Consider switching to lower-impact exercises such as cycling or swimming.
5. Check Shoe Flexibility: Avoid shoes that are excessively flexible in the forefoot. If a shoe bends too easily at the toes, it forces the metatarsal heads to press harder into the ground.
Medical Intervention
Currently, medical treatments such as fat grafting or injectable dermal fillers have not shown consistent long-term benefits for fat pad restoration. Therefore, conservative management through lifestyle and footwear changes remains the gold standard for care.
Disclaimer: This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition.
Lori DeBlasi, DPM, FACFAS
Dr. Lori DeBlasi is certified by the American Board of Foot and Ankle Surgery®. Dr. DeBlasi works at Family Foot & Leg Center at the Estero office. She is accepting new patients.
To make an appointment, call 239-430-3668 or visit www.NaplesPodiatrist.com.
21401 Corkscrew Village Lane,
Suite 4
Estero, FL 33928
(239) 430 – 3668 (FOOT)
www.NaplesPodiatrist.com