Symptoms of Plantar Fat Pad Atrophy

Neuroma

A neuroma is an enlarged, damaged nerve at the ball of the foot.  The most common site of neuroma formation is at the third interspace.  The second most common site of neuroma formation is at the second interspace. The nerve continuously gets stuck when walking between the metatarsal bones causing thickening of the nerve and sharp, shooting, or tingling types of pains.  A preliminary treatment option is a cortisone shot.  A cortisone shot may decrease the pain and inflammation at the ball of the foot.  Sometimes surgical removal is necessary for relief from neuroma pain.
Can cortisone shots cause fat pad atrophy?

Cortisone shots may help relieve the pain due to the neuroma by decreasing the inflammation and size of the neuroma.  If cortisone is given in excess,  there is the potential for atrophy of healthy fat tissue and bone strength around the injection sites. Fat pad atrophy ultimately leads to decreased shock absorption and cushioning in the feet, increased trauma to the bone on ambulation, and the potential for significant foot pain.
Trauma / Scar Tissue

Trauma to the foot caused by a spontaneous accident or iatrogenically (i.e. by surgical management) may decrease subcutaneous tissue thickness in the foot.  A patient might develop a surplus of scar tissue and fibrosis with loss of the fat pad secondary to trauma.  This leads to pain in the feet on stance and ambulation.
How does autologous fat pad replacement help post traumatic pain and pain from excessive scar tissue formation?

Fat cells are harvested through liposuction of one's belly or thigh.  It is processed in a special way to best maintain the integrity of the fat cell and even the stem cells in the fat.  When injected into the foot, if there is scar tissue, the scar tissue is broken up prior to depositing the fat cells.  Ideally the fat cells increase the cushion under the painful area in the foot, increase shock absorption to the area on ambulation, and decrease pressure ultimately relieving one’s pain. It is thought that the stem cells in the fat that is transferred has the ability to release certain growth factors that promote new fat cell growth and increased blood supply to the area.
Metatarsalgia - Ball Of Foot Pain

Pain at the ball of one’s foot is a very common complaint and may be due to many factors.  Long term high-heel shoe wear puts an extreme amount of pressure on a woman’s forefoot.  With lack of fat padding and cushion, high-heel shoes may cause diffuse burning, pressure, and pain to the ball of the foot.  Fat grafting to the foot may offer some greater internal cushion to the front of one’s foot allowing for decreased pain and an increased duration of fashionable shoe wear.
Stress Fracture / Stress Reaction

If metatarsalgia progresses, one has the potential to develop a stress reaction or stress fracture of the bone.  Bone is comprised of a hard outer shell (cortical bone) and a soft inner shell (medullary bone).  Excessive repetitive pressure on a bone can cause inflammation in the soft inner shell (stress reaction) or longitudinal cracks in the soft inner shell (stress fracture).  Stress fractures are usually accompanied by foot swelling.  Increasing one’s fat pad thickness and decreasing the pressure on bone when ambulating has the potential to minimize stress fracture and stress reaction recurrence.
Callus

Certain shape foot types have bones which are lower to the ground than neighboring foot bones.  As a result, when walking, the bone lowest to the ground assumes a great amount of pressure.  It wears away at the fat cushion protecting the skin on the sole of one’s foot.  As a result the skin tries to form its own protective barrier by building up thicker skin.  The skin on the sole of the foot can only become so thickened before it starts to cause pain, pressure, and even break down to an open wound.  Fat grafting n may rejuvenate the fat pad between the bone and skin on the sole of the foot to limit pressure, pain, and callus formation.
Hammer Toe Deformity

A hammer toe is when one’s toe bends at the joint.  Due to the toe contracture, one may develop thickening of the skin at the joint area along with occasional redness, swelling, and tenderness from continuous shoe irritation.  The hammer toe may be flexible with the ability for the toe to straighten when pulled.  As a hammer toe deformity progresses, it may become rigid.  By injecting one’s own fat, under the skin of the irritated area over the joint, shoe gear irritation and lesion formation have the potential to be minimized.