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Plantar Fat Pad Atrophy ?

Discussion in 'Ask your questions here' started by Jack, Jun 17, 2008.

  1. Jack

    Jack Guest


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    Hello Everyone,

    First of all I’m a 61 years old male. I’m 6’4” tall and weigh 210 lbs. I’ve always been very active and athletic, walking three or four times a week for a distance of about four miles each day. I normally walked at an 11 to 12 minute mile pace. I bowled professional senior events throughout the NW. I also walked while playing golf two or three times a week. I used to have normal feet except for high arches and having once gone through a bout with Plantar Fasciitis back in 1995-96. Then nearly 21 months ago (January 2006), while walking bare foot on the beach in Maui, I sensed some rather sharp tingling sensations/pain in the central metatarsal area of my left foot. The pain was such that I turned around at that point (having already walked about a mile) and returned to my condo.

    After returning to the mainland my pain continued to worsen. After a couple of months, I visited the best orthopedic foot surgeon in my area, who took x-rays and such and basically was told to see an Orthotist to provide me with custom orthotics to help relieve pain derived from a Morton’s Neuroma. The Dr. also recommended stretching my calf muscles and Achilles tendons. At this point, my right foot is beginning to exhibit similar sensations of my left, so I had the Orthotist provide a matched pair of orthotics to hopefully keep my right foot from getting as bad as my left. Both of these orthotics had a Metatarsal pad to help relive this so-call neuroma pain.

    Not getting any better after a few more months, I decided to see a Podiatrist and get another opinion. He seemed to think I also had a Morton’s Neuroma in my left foot. He also noticed the forth toe on my left foot was starting to form into a “hammer toe”. He also mentioned the possibility that the padding on the bottom of my feet may be “thinning”. In the end, all he recommended was for some thicker cushioning for my shoes.

    Anyway another four or five months go by and I’m getting worse to the point that I can’t even take a shower without wearing a pair of flip-flops. I no longer can walk and carry my bag while playing golf. Exercise walking is now out of the question on hard surfaces. I’ve now also totally given up recreational and tournament bowling.

    So at this point I decide to see another Podiatrist after researching to find the best Pod in my area (Portland, OR). All he basically recommends is to replace my custom orthotics with a pair of “Superfeet” brand arch supports and buy some New Balance walking shoes with a really large toe-box area. He says I’m experiencing plantar fat pad atrophy.

    I’ve researched the Internet endlessly and not really found much related information. However, I did run across a company in Canada that’s conducting testing of a procedure that restores thinning plantar fat pads by injecting a gel-like material directly into the fat pads.

    I also understand there have been several Podiatrists that have used similar injection procedures over the last several years.

    So here I am, nearly another year later and seemingly getting worse on a daily basis with no help in sight. And now I even have Planter Fasciitis again in my left foot. I’m getting more out of shape all the time. I’m getting really depressed. I just don’t know where to turn.

    I’ve personally always taken a very aggressive and proactive approach to any ailment or physical problem I’ve ever experienced. Now it seems there is nothing I can do.

    Is there anyone else out there that is going through this misery? How bad does this get? What can I expect?

    Is there anyone out there who can help me?

    I just can’t give up !

    Thinks for Listening,
    Jack
     
  2. FootDoc

    FootDoc New Member

    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS- ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
    ***********************************************************
    Age related plantar fat-pad atrophy is common, as is such atrophy related to specific conditions including rheumatoid arthritis. Pain and discomfort will normally be accentuated in the exceptionally high-arched foot, as an inappropriate amount of weight is borne on the balls as well as the heels of the foot with not enough dispersion of body weight elsewhere on the plantar. Various injectable substances have been tried, but, to date, and to my knowledge, nothing in terms of actual replacement or internal simulation of the fat pad has proven very successful, and one is pretty much left to external pads and cushions and materials to reduce direct and shearing forces. But you might be glossing over the possible Morton's neuroma too lightly. Although padding treatments can sometimes mitigate symptoms, rarely, in my experience do they provide permanent or even long-lasting results.
     
  3. Jack

    Jack Guest

    Foot Doc,

    Thanks so much for your reply...

    Considering the time frame I have described (21 months) and my relatively young age for this type of affliction, am I experiencing a typical decline from normality to my present condition?

    How much worse and how fast a decline should I anticipate? Is there anything I can do to slow this decline?

    Diet?
    Exercise?
    Stretching?
    Massage?
    Pharmacological Pain Management
    Weight Loss?
    Shoes?
    Socks?

    Could you also please provide more info related to your concerns regarding the Morton’s neuroma issue?

    Thanks Again,
    Jack
     
  4. FootDoc

    FootDoc New Member

    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS- ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
    ***********************************************************
    A pre-requisite to considering any specific prognosis or how one might attempt to change it for the better would be an accurate diagnosis and etiology. Diagnoses and findings are not the same thing. But Internet forums are not likely venues to obtain diagnoses, which generally are to be based of a hands-on examination.

    It was you who brought up the diagnosis of Morton's neuroma, and this condition certainly is a common cause of pain in the ball of the foot. It is not generally a difficult diagnosis to make, but it can present with varying symptoms, from paresthesias such as tingling and burning, to frank numbness to out and out pain. I was simply advising that some or part or perhaps the whole of your problem could be symptoms of the Morton's neuroma which you say was suspected, even in spite of the fact that you may have concomitant fat pad atrophy.

    In my experience, an accurately diagnosed Morton's neuroma generally requires an invasive procedure to remove, destroy or decompress the neuroma in order to afford other than temporary relief.
     
  5. Jack

    Jack Guest

    Dr, thanks again for your reply...

    Do you have knowledge in regards to injection procedures to restore fat pads?
     
  6. FootDoc

    FootDoc New Member

    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS- ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
    ***********************************************************
    Jack wrote:
    -------------------------------
    Dr, thanks again for your reply...

    Do you have knowledge in regards to injection procedures to restore fat pads?

    ========================================
    Just that several substances have been tried, and, to my knowledge, none have had any substantial long-term success.
     
  7. Unregistered

    Unregistered Guest

    Look at this link... this will help you:

    http://wmt.test.lunaweb.net/Downloads/Techniques/Plantar Augmentation Tech.pdf

     
    Last edited by a moderator: Dec 30, 2008
  8. Unregistered

    Unregistered Guest

    is getting fat foot

    My bf and I we went to play racketball and we have no idea what;s is going with his foot. Next day his foot was getting fatter and fater. He never have problems like this. so is there any other way for him to get of it the pain
    '
     
  9. Unregistered

    Unregistered Guest

    I have had this problem for years. I was in my 60's when first symthms started. Now 75. I sleep on a magnetic matress pad. I have no pain and walk with regular shoes. I can run if I wantto. Only drawback is I feel asif I'm walking on a sponge.
     
  10. Footless

    Footless Guest

    I feel your pain! I too have Morton’s Neuroma. The custom orthotics have helped to a degree - especially the metatarsal pad built into them. I am also looking for some help because not only am I in constant pain when I walk, which gradually worsens but I feel it is also zapping my energy. I feel tired all the time. I have been to the doctors about the fatigue and they find nothing so I am beginning to feel that the inflammation of the nerves in the feet are the problem.

    I have read elsewhere on the net that acupuncture has given relief to some. I also hoped that my own fat injected into the soles of my feet would work but haven't found any information on that.
     
  11. I don't have pain, but on the bottoms of my feet, right under my toes, feels like walking on sponge, or something in my shoe.
     
  12. FootDoc

    FootDoc New Member

    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS- ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
    ***********************************************************
    Although certainly not to be taken as a diagnosis, the symptoms you relate are often seen in patients with peripheral neuropathy.
     
  13. Unregistered

    Unregistered Guest

    Hello Doctor,

    I have the same problem as Jack does above... Except I am 26years old.
    I have been researching and have kinda pin pointed the sympotoms my self.
    I've have been to 3 doctors who have only wanted to remake a new orthadic for me and never really answering my question of what is wrong with my foot and why I have so much pain on the balls of my foot.... the answer to all these doctors are x rays and orthadics....

    Can you recommend a good doctor in the New York City area?

    I beleive I have fat pad atropy because I can feel the bones under my feet and I can also see that the orthadics have created calluses too becasue they are not soft, so I am better walking with out them...

    This bites for a 26year who is now having to wear MTBs and granny shoes...

    a
     
  14. Unregistered

    Unregistered Guest

    I've read the posts in this column with interest as I have had a 24 month problem with pain in my left foot. The pain is around the sesamoid bone in my left foot (ball of the big toe thereabouts). I have been to see 3 different doctors, 2 podiatrists and a foot surgeon. It seems there is some confusion in the diagnosis - between Mortons Neuroma to a fractured sesamoid bone - so I have been asked to get a bone density test/scan of some sort (these are soooo expensive..). I was told not to run (I love to run) and I stopped for 6 months - all this time a little lump has developed in the "sesamoid bone" area - and now when I am walking it feels like I am standing on a grain of rice. Needless to say - it hurts like buggery...it can feel like a burning sensation sometimes and then can be a stabbing pain at other times.

    I've given up on the not running bit and I run 3 times a week (5k) and just grit my teeth through the pain...seems like after I'm warmed up (around the 1k mark) the pain goes away...(some times I am lucky and I sleep fine through the night other nights I get stabbing pains at 3am that gets me out of bed)...

    Like Jack - I'm wondering if there is anyone out there who might be able to suggest some other condition that I can take back to my doctors as suggestions...we seem to be out of answers here...I've had xrays and scans - nothing shows up...orthotics and gel pads etc have not helped at all.

    Thanks people

    Caroline
     
  15. FootDoc

    FootDoc New Member

    ***********************************************************
    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS-ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
    ***********************************************************
    Pain in the sesamoid area is generally termed sesamoiditis. Certainly at least one of your 3 doctors could tell the difference between an irritated sesamoid area and a sesamoid fracture, and would know that a Morton's Neuroma does not cause the sort and location of symptoms which I hear you describe. Nor do I know why a bone density scan is warranted.

    You have mentioned no definitive treatment other than not running, and certainly your doctors offered you more than that in justification of taking your money. Has anyone considered perhaps a corticosteroid injection into the sesamoid area, real off-loading padding or maybe a sesamoidectomy?
     
  16. Unregistered

    Unregistered Guest

    Heya Foot Doc,

    Thanks for the reply. Cortisoid Injections & an op was discussed by the surgeon but he wanted me to have the bone scan first. I think he said something like he couldn't be sure from the xray if I have a bipartite sesamoid or if it was indeed a fracture. I'm certainly not going to have the operation - I don't want any bones removed...

    Guess I'll go have me a bone scan and take it from there. My foot is only slightly swollen so I'm hoping that it isn't a fracture (trying to be optimistic here!)...I've got a half marathon coming up in July...

    Thanks again for your reply...
     
  17. FootDoc

    FootDoc New Member

    ***********************************************************
    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS-ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
    ***********************************************************
    Your choice. It's ONLY pain. No one RELISHES having parts removed, but when appropriately and properly done, the trade-off is usually a good one. If nothing definitive is going to be done, I don't see the need to know if it is a fracture or a bipartite sesamoid. I certainly would have you think again about running a marathon on a foot which is to any degree painful and swollen.
     
  18. Jack

    Jack Guest

  19. Unregistered

    Unregistered Guest

    Hi,
    Has anyone checked into Dr. Thomas Rocchio and his Graftjacket technique to treat atrophy of the plantar fat pads?

    I have severe atrophy of the plantar fat pads plus progressive peripheral neuropathy and I am constantly trying to find something that will help. My feet are simply skin and bones. It is excruciatingly painful to walk the few steps.

    The study indicates the procedure has been done on over 50 patients. I have searched blogs and web sites to see if I can find one of the patients commenting on the procedure. I know that if I had it done and I saw improvement I would be on every blog and web site telling everyone about it. Does anyone know of someone who has had procedure done and their results? Thank you. Chris
     
  20. Unregistered

    Unregistered Guest

    This may be a Freudian slip that I forgot to mention that my feet are so severely devoid of fat due to atrophy that I will soon need to choose between sitting in a wheelchair or having my feet amputated and wearing prosthesis if I want to walk. I also have progressive peripheral neuropathy which makes my feet feel as if they are on fire.

    Therefore I appreciate any hope something which may be on the horizon. Obviously, stem cell would be ideal but our country is so are behind in stem cell research that I doubt it would help anyone within the next 20 years for this type of problem Thank you for any suggestions. Chris
     
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