Q: What do feather beds, swimming pools and leaf piles have in common?

A: Fat.

What, that’s not the answer you were expecting? But it’s true. Think about the reason why you can jump into a pool or leaf pile or feather bed. Because you know you will have a soft landing; the water, leaves and feathers will protect you from hitting the hard ground. The fatty deposits in our bodies were designed for a similar purpose – to insulate and protect our fragile organs and also to help absorb shock in our skeletal system.

Did you know that you have fat in your feet?  And it’s a good thing too.

The blue markings on the foot above show the areas that are covered by a thick fat pad. You will notice that it pretty much corresponds to every part of your foot that touches the ground. This is not a coincidence. We contact the ground with a relatively small surface area that is comprised of the boney structure of our feet. The pressure in these areas can measure up to more than 8 times your body weight as you go about your daily activities.  Cushioning is necessary to say the least.

The adipose cells in the fat pads of your feet act a little bit like the plastic balls in a playground ball pit.

The cells are small, individual packages of fluid that squish around independently to adjust to the surface you on which you are standing and the area of the foot that needs padding at the time.

As we age, the fatty padding on the bottom of the foot tends to disperse and thin. This is called  “Fat pad atrophy”. Older people and those who spend excessive time walking or standing on hard surfaces are especially susceptible to this condition.  High arch feet are also more likely to experience this problem because they have a disproportionally small amount of ground contact area, leading to heavy pressure spots in the heel and under the metatarsal heads.

Think of fat pad atrophy as being like a ball pit that doesn’t have enough balls.

There is little to no shock reduction in most areas, leaving your bones directly exposed to pressure and pain from contact with the hard ground.

The foot below is supposed to illustrate fat pad atrophy:

See the green spots? They represent adipose cells that have gotten squished down and displaced to sides. The red and orange areas show places where repeated pressure on the uncushioned bones can cause damage and pain. You notice that there is a lot of fat squished towards the outsides of the heel and underneath the crease of the toes. Many of my patients with fat pad atrophy tell me that it feels like their socks are wrinkled up under their toes all the time.

One of the best treatments for fat pad atrophy is a pair of soft, cushioning orthotics. This is one of the few occasions when I advocate the use of those nice, squishy, gel inserts that you can buy in every pharmacy. If the problem is not too severe, these cheap over the counter inserts will work wonders. Unfortunately, fat pad atrophy is often accompanied by (and probably originally caused by) an underlying alignment issue, such as supination or pronation.  If this is the case, the best solution is a set of custom molded orthotics built with high sides to surround the foot and push the fat pad back underneath.

Wearing well made, cushioned shoes will also be an important part of overcoming fat pad atrophy. One of my favorite shoes for this purpose is the Brooks Dyad. This sneaker is like a marshmallow that you tie onto your feet. It manages to be extremely cushioned while still providing a reasonable amount of support and stability.

Fat pad atrophy will never fully go away, but if you are diligent about providing your feet with extra cushioning, your pain will gradually subside as the damage on your bones has a chance to heal.   The moral to the story is – don’t take your fat for granted!

Walk well.

Pictures from: