Collagen Injection In the Balls of the Feet for Fat Pad Atrophy

Fat Pad Atrophy is a condition that refers to the loss of fat pads on the feet, which causes thinning of the protective cushioning fat pad that sits under the bones in the ball of the foot.

This is commonly seen in elderly people and can cause significant pain while walking, as the shock absorption from the fatty tissue is no longer there.

Without the fat pads the whole body’s weight shifts onto these bones with minimal to no protection. Therefore the load under this area is unable to be spread out effectively leading to pain, inflammation, and over time possible damage to the bones.

Although plantar fat pad atrophy affects both men and women equally, the choice of footwear makes women more susceptible to developing pain and calluses on the ball of the foot. A callus that is not treated may lead to ulceration of the underlying tissue.

Similarly, there is a fat pad under the heel bone. As we stand or walk, the body weight is transferred through the heels and ball of the foot, so both these areas need protection.

Sadly, stylish and trendy women’s shoes don’t always take their wearer into consideration. Because many people are slaves to fashion and will sacrifice comfort and their feet for the sake of looking good in the short term, accelerated damage is done to balls of the feet. Occasionally, fractures and soft tissue injuries occur, but most of the time it is just pain at the ball of the foot from loss of natural padding and/or the shift in this padding coupled with the increased pressure placed on the metatarsal heads from high heeled shoes

Although conservative options are available, these are impractical for extremely stylish shoes. If you must wear Jimmy Choo, Christian Louboutin, and Manolo Blahnik, to name a few, you may be a candidate for this innovative procedure.

Symptoms of Plantar Fat Pad Atrophy (Loss of Fat Pads on Feet):

  • Experiencing pain in the ball of the foot, worse when barefoot, in heels, or thin soled shoes.
  • Pain which is greater when standing and relieved when sitting.
  • The feeling of having a small rock in the shoe.
  • Calluses may appear and become very thick on the ball of the foot.
  • When feeling the balls of the feet, you can feel the bones without much overlying fatty tissue.

Causes of Plantar Fat Pad Atrophy (Loss of Fat Pads on Feet):

  • Age is the most common cause, as fatty tissue is reduced in the foot, like it is around the rest of the body.
  • Collapsed long bones in the balls of the feet or prominent metatarsal head cause increased pressure on the ball of the foot, which can overtime wear out the fat pad protecting the area.
  • Wearing high heels, walking barefoot, or in very thin soled shoes may initiate or exacerbate the condition.
  • Extremely high arches increase weight through the balls of the feet.
  • Excessive pronation (rolling in) as increased pressure is put on the balls of the feet.
  • Injury to the ball of the foot, multiple surgery incisions, or fractures can lead to thinning and displacement of the fat pad.
  • Genetics are considered to be a cause behind excessive loss of fat pads on feet.
  • Rheumatoid arthritis, which causes clawing of the toes and more prominent bones in the balls of the feet.
  • There is often thinning and loss of fat pads on feet in people with diabetes, especially if they have neuropathy (no feeling), which increases the risk of developing foot ulcers.

Treatment for Fat Pad Atrophy (Loss of Fat Pads on Feet):

  • Avoid activities that require walking on tiptoes, squatting, walking down a slope or any action that puts pressure on the balls of the feet, this includes wearing high heels.
  • Wear low heels (an inch or less) and avoid walking barefoot.
  • Switch high-impact weight bearing exercise to low-impact alternatives, such as cycling, swimming, and pool running.
  • Wear supportive orthotics with a soft top cover to evenly distribute weight to the soles of the feet and provide adequate shock absorption and comfort.
  • Soft paddings may also be beneficial and suggested by your podiatrist.
  • Wear supportive footwear that also provides cushioning to the feet.
  • The use of Collagen DermaFillers which adds cushioning, can be safely injected into the areas of soft tissue atrophy under local anesthesia without incisions. Relief can be obtained for six to 12 months depending on the specific product used.
  • Another technique utilized is fat transfer where fat is harvested from either the abdomen or the thigh and then transplanted to the balls of the foot.

With time and age, the fat pad on the bottom of our feet begins to atrophy, losing its thickness and resilience. This is termed “plantar fat pad atrophy.”  Deep tissue atrophy can also be found in the toes and heel.  It is a normal, albeit unfortunate, aging process and can contribute to considerable pain and deformity on the bottom of the foot and on top of the toes where corns may also be present.


If you are dealing with pain in the ball of your foot it may be due to a loss of fat in the pads. Dr. Nathan Lucas and our team at Renuva Xtremity can help you find the right treatment option for your ball of foot pain. Contact us today to learn more!

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