Fat Pad Atrophy Forefoot

Chief Complaint

  • “Aching” pain at the ball of foot under the bones
  • pain worsens with increased weight bearing
  • shoe padding may take the “edge” off
  • “ feels like I am walking on bones/rocks/marbles”
  • possible history of neuroma excision, forefoot cortisone injections
  • possible history of over use/over training history

Exam

  • Diagnosis of exclusion
  • metatarsal heads easily palpable and painful on palpation
  • possible plantar skin discoloration
  • seen most commonly in the rigid high arch foot ( but not exclusive)

Fat Pad Atrophy Heel

Chief Complaint

  • Pain at plantar central heel on palpation
  • pain with increased weight bearing
  • “feels like a screw/bore jamming into the heel”
  • may have been treated for plantar fasciitis
  • possible history of cortisone injection
  • tried and failed insert/orthotic management

Exam

  • can feel heel bone easily
  • pain on palpation of the plantar central heel
  • a high arch foot or flat foot with lateral heel fat pad displacement
  • heel skin quite deflated and wrinkly when squeezing the heel

Chronic Plantar Fasciitis

Chief Complaint

  • plantar medial heel pain that persists for 6 months or more and failed conservative  treatment such as arch support,cortisone injection, physical therapy, night splint.
  • excruciating pain first thing in the morning or when rising from  a seated position.

Exam

  • extreme pain on palpation of plantar medial heel at the insertion of the medial band plantar fascia on the heel bone
  • heel pad may be plump with minimal to no plantar central heel pain on palpation
  • high arch or flat foot
  • usually pronated on stance
  • on ultrasound insertion of plantar fascia measures 4 mm in thickness or more.

Patients who will NOT benefit from fat grafting to feet

  • deep callus with a core
  • active smoker