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Old 09-27-2012, 01:54 PM   #1
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Metatarsal Fat Pad Atrophy

Hi everyone,

My name is Jacqueline and I am 21 years old. I started having pain in the ball of my foot a year and a half ago (probably from overuse - I did gymnastics and dancing).

I received multiple cortisone injections to relieve my pain last year. They did not help. I finally received relief from the original pain from a physiotherapist (it was capsullitis - inflamed joint tissue). However, once that injury had gone I noticed that the ball of my foot felt bony and I couldn't stand on it.

I have been to a couple of doctors and they both say I have atrophied fat-pad in the ball of my foot from the cortisone injections. and they said it will not grow back!!! I was not made aware of these side effects before being given the shot.

This was extremely hard to hear. This foot problem has made me very depressed because I can no longer do any of the things I used to enjoy. I can't walk or stand without pain. No more gymnastics, no more dancing and absolutely no running. I can't drive because it puts pressure right on the part that hurts. I cannot stand bare foot. I have started gaining weight because I can no longer exercise without pain (although I have recently taken up swimming). Walking to school and the grocery store the next block over is painful. Even with orthodics specifically designed for this problem!!!

I live in Canada and have been told by many that no treatment exists here. I find it hard to believe that someone can give you a shot that has possible untreatable, potentially life-ruining side effects!!

If someone knows of any treatment that could help me PLEASE reply!

Thank you!

Last edited by moderator2; 09-27-2012 at 02:11 PM.

 
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Old 09-27-2012, 02:54 PM   #2
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Re: Metatarsal Fat Pad Atrophy

There are treatments for this with injections of fat and/or other things. I saw a segment on the Today Show here in the US about it several years back. I'd see a podiatrist or a dermatologist. You could try inserts as well.

 
Old 09-27-2012, 02:57 PM   #3
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Re: Metatarsal Fat Pad Atrophy

Hey, Thanks - I did see a podiatrist who said there was no treatment ...but maybe just none in Canada? Dermatologist is a good idea - I will look into that!

 
Old 09-28-2012, 12:11 PM   #4
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Re: Metatarsal Fat Pad Atrophy

The cortisone injections were the worst possible thing that could have been done. It disolves fat and there is no remedy. Injections to replacee fat don't work. Do you homework, search the net, they have been tried over and over to no avail. The physician who injected you with cortosine should have his license pulled in my humble opinion.

You should try several podiatrists as most won't have any answers for you. I don't know if the Canadian health care system will allow you to do that so go around the system if you need to and pay out of pocket as this is a biggie that will affect you for the rest of your life. You need the best possible answer.

I have no fat under the ball (metatarsil heads). I had two surgeries for a Morton's Neuroma before having my metatarsil heads shortened. I had cortoson injections at the time (very bad thing to have had done). The last surgery made things worse than they were to start with. I now cut a 1/8 felt pad that goes around the most prominant metatarsil head sticking down to dispurse the load. That won't work on your foot as there is only the heal bone.

I really feel for you as life is never going to be the same. I am seeing my podiatrist again next week and will ask if he has any suggestions for fat pad atrophy in the heal. If so I will post something here again.

Fred

 
Old 09-28-2012, 12:16 PM   #5
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Re: Metatarsal Fat Pad Atrophy

Thank you for your response Fred. I really hope that there will be a remedy some day as yes, this has completely changed my life. I am sorry that the surgery left you worse off.

You said you were going to ask about fat pad atrophy in the heel - it actually is my metatarsal heads that have no padding. I saw a podiatrist about it and he made me orthodics with extra padding for the foot that is injured. My problem is that it is still uncomfortable even with this pad. I am hoping to find a surgeon or someone who will be able to do something. Maybe with stem cell research something will come out of it?

 
Old 09-28-2012, 05:28 PM   #6
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Re: Metatarsal Fat Pad Atrophy

I wouldn't hold my breath on stem cell research and would caution you about surgery. I put it off for years fearing I might be one of the 15% who have surgery where the problem worsens and in fact I am.

Is the problem across all your metatarsal heads or just one or two? If one or two then you can be creative and create some padding to distribute the weight. I use adhesive felt and cut it in something of a U shape to fit around my third metatarsal head. I then tape it down Tenoplast tape.

I would suggest you try HappyFeet. They are essentially an glycerin filled insole. The fluid moves around as the pressure moves from the rear of your foot to the front. I am sure you will find them at least partially helpful.

Fred

Last edited by Administrator; 09-28-2012 at 05:49 PM.

 
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Old 09-28-2012, 08:51 PM   #7
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Re: Metatarsal Fat Pad Atrophy

Hi Fred,

It is across all of my metatarsal heads...so it kind of feels like a general burning sensation in the ball of my foot I guess from the friction (I think of when I used to do gymnastics and my hands would burn after doing the bars)...Right now I have orthodics with a pad built in but as I said, its not that helpful. Maybe the best thing would do would be to find a good podiatrist to help me figure out how to redistribute the weight the best? I will definitely look at Happy Feet! I can't imagine it feeling like this for the rest of my life...and am discouraged when I read posts by people who say it only got worse..

I did find something in my search that might be helpful/i'm going to look into...I found a Lit Review on Silicone Injections for ball of foot atrophy written in 2010. It seemed very positive...could last for 6 mnths - 2 years and considered a safe procedure. The only thing is that is says "the availability and production of injectable silicone and medical-legal factors have reduced the potential for widespread implimentation"...so I"m not sure what that means. Have you heard of this procedure?

Thanks!
Jacqueline

 
Old 09-28-2012, 09:10 PM   #8
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Re: Metatarsal Fat Pad Atrophy

Silicone injections can be fraught with problems. The silicone can shift in location, cause inflammation and scar tissue, infection, and then your feet could hurt worse. When they refer to medical-legal issues, they are most likely referring to law suits. Silicone is a foreign body and can stimulate the immune system to try to eradicate it. There is no good way to get it out once it is in there. I think that fat injections have improved, and small amounts can "take" successfully. The fat should come from your own body to avoid rejection issues. Plastic surgeons do these on the face all the time. It might be worthwhile to at least talk to one or two, and get a consult with an orthopedic surgeon that specializes in feet, before you do anything. I do hope you find something safe that works.

 
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Old 09-29-2012, 06:42 AM   #9
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Re: Metatarsal Fat Pad Atrophy

Hi- I'm new to this board. So glad I found this community.

A year ago I had surgery on both feet for Morton's neuromas (2 neuromas in each foot; each was the size of a marble). My DPM said I'd be healed in 3 months, but post-op standing was painful for me. He suggested cortisone injections; I had a total of 4. Prior to the surgeries I hadn't gone barefoot in years, even to shower. I thought the pain was due to the neuromas (which are painful, like standing on a toothache). Now I realize that my fat pads were thin before. And they're worse since the surgery.

My pod says I developed the neuromas because my transverse arches had collapsed, so he recommended orthotics with hefty met pads and lots of padding. He denies that the injections thinned the fat pads, but I know they did.

I can walk without pain only if I wear rocker-sole shoes with the orthotics AND with liquid insoles. Jackie, you may want to search for a provider who injects Sculptra into the feet. From my research, that substance has a longer lifespan and has been used more successfully in the feet. Google "Pillows for the Feet". I'm near Denver and I'm searching for someone here who can do that. Sculptra is a natural substance, nothing like liquid silicone, which is dangerous. Good luck!

 
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Old 09-30-2012, 06:40 AM   #10
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Re: Metatarsal Fat Pad Atrophy

Some people have had success with injections of one substance or another but the injections of "fake" padding is limited, expensive and needs repeated. Unfortunately, fat pad atrophy in the ball of the foot is painful. I would look at your Achilles tendon. Having a tight Achilles tendon will force your center of gravity from your anterior ankle toward your forefoot. If your do sequential leg lift stretches and eccentric stretching that could help. I would be very serious about inserts with padding. Do everything conservative then consider sx if you are not getting any relief.

 
Old 09-30-2012, 08:18 AM   #11
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Re: Metatarsal Fat Pad Atrophy

Yah I have been using orthodics/ padding for 5 mnths now and it hasn't really helped...constant pain when trying to do what healthy people do (such as grocery shopping, etc.) no matter what, I really have no padding left. So I am seriously considering injections/surgery now. The way I see it I would give any amount of money to have the use of my foot back - I am 21 and haven't experienced so many things that I need it for! So even if I have to get injections every six months, if it works I'll do it.

 
Old 09-30-2012, 09:11 AM   #12
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Re: Metatarsal Fat Pad Atrophy

Jackie, have you tried rocker-sole shoes like Skechers or MBTs? Rocker soles can offload 40% of the weight on the balls of the feet. Liquid insoles also help.

I haven't been able to do weight-bearing exercise in over a year, but found two options that keep me sane: 1 - Aqua jogging/AKA water running in deep water: it's like running on land, but with no impact. I wear ankle and wrist resistance bands and get a great workout. 2 - Pilates on a reformer: non-impact way to tone the entire body, exercising mostly on your back, not your feet.

I don't know what type of surgery you're considering, but I hope you'll try other options first. Keep us posted and good luck.

 
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