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