(walls crashing) – Today, we are talking
about fat pad atrophy. So in the ball of the foot right here, and along the bottom right here. So your fat pad is normally about one to two centimeters along the heel, but when you get old and a
lot of other things happen, it shrinks down, you can
feel the bones, they ache. So they're aching down here, down here we go over
the best new treatments. How to fix it without doing surgery, all the best stuff available, the products, how to get better, and then for those where
it's not getting better surgical options that
we're starting right now. Guys, thank you so much
for watching this video. We appreciate your likes,
your subscribes, your comment. We really love hearing
if this stuff helps, is it really makes a big
difference for us, so thank you. So fat pad atrophy is
not perfectly defined. At the bottom of the foot,
usually in the ball of the foot and along the heel is where it develops.

So normally you have
about two centimeters, which is about an inch
of fat pad in the heel. And generally it shrinks
down to under one centimeter. There's no perfect explanation, but usually it is associated
with a few risk factors, and I'll go over how we diagnose it. So the diagnosis is go
see your podiatrist, that's always a disclaimer
in these videos. Because what happens is, a lot of the times you
can misdiagnose yourself, and you waste years
diagnosing the wrong thing.

So for example, a lot of
heel pain can be stuff like plantar fasciitis, a
fractured heel, a heel spur. But people are treating fat pad atrophy which has different treatments. So really getting an
evaluation if you're stuck, if you're in trouble, I
know it's not always easy, but basically x-rays, MRIs,
ultrasounds, physical exam. This is what we can do
as a podiatrist to see how thin or how thick that is. Is there a fracture? Is there a heel spur? Is there plantar fasciitis? Do you have a torn ligament
in the ball of your foot? That's the trick.

Because a lot of times, fat pad atrophy should be correctable
without doing surgery, and some of this stuff should work. If it's not getting better, if
you're having a lot of pain, then it's probably something extra that your podiatrist
should take a look at. So risk factors for fat pad atrophy are, number one, people with health conditions. So if you have diabetes, if
you have lupus, scleroderma, if you have psoriasis,
auto-immune conditions like that, rheumatoid arthritis,
especially rheumatoid arthritis, you can lose a lot of fat pad. If you don't have these,
it's probably good news. But the next thing is, if you have a lot of damage repetitively, are you on your feet all
day on hard concrete? Are you a runner who does
like a hundred miles a week? This causes inflammation in your foot and is more likely to damage the fat pad.

Same thing if you're a heavy person, and same thing, this a big one, is a high arch. If you have a high arch, so if your arch is pretty tall like this, you're more likely to have it than someone who's pretty flat,
although both can have it. Another one is injections. If you get a lot of steroid injections that fat pad can shrink down
over a five to 10 year period.

But don't let that throw you off too much because realistically, I don't personally see it
with like one or two or three, we're talking probably
like 10 injections or more. The most common cause though is age, so if you're like 60 or
70 years old or older then this might be fat pad atrophy. So here's the treatments. Treatment number one, is don't
walk around barefoot at home, get a good pair of orthotics slippers. So I love slippers like this, see how it has an insert built into it. This is an old pair right here, but this is a great brand called Spenco's.

I love these, there's a lot of cushion, there's an arch built into, it's already got an
orthotic built into it. Most people get fat pad
atrophy pain at home because they're barefoot. Get a good supportive slipper, links are below to our favorite shoes. Check it out, that's
really gonna help out. Number two, is get a great shoe. Look at how much cushion there is here. This really helps out and
look at how stable this is. It's got a stiff heel, stiff bottom, it's thick through the bottom, it's got a lot of thickness in the front.

That really helps so. Another pair is maximalist
shoes like this. Look at how thick that is, that's a lot of foam cushion, it's a lot of foam cushion up front. It's got a curve along the bottom, so see when it walks, it curves. Look at all that cushion. Even with fat pad atrophy, if you can wear a good
supportive shoe like that, that pretty much solves
the problem right there, you can stop watching the video. No, don't stop, there's
some more good tips coming. Because not everybody wants to
wear shoes 100% of the time. But if you wear a shoe like that, look at, there's no cushion here, this right here is flexible. If you don't have a fat pad, and your shoe doesn't have any protection, you're not gonna get any pain relief. But on the other hand, if you're wearing
something thick like this, even without a fat pad
losing like a centimeter, it's almost not even
something you can tell with how thick this is.

So that does a great job right there. The next thing you wanna do
is grab an insert, look at, it's nice soft, it's got an arch. So it puts pressure into
your arch right here, and it puts a lot of cushion. This is one where even the
soft over-the-counter insoles can really help out. So see right there how the
foot's not flattening out, whereas right here, look at
how much those bones press in. So right here, it's not
that it's just the cushion, although the cushion helps, but it redistributes the pressure. Whereas right here,
nothing's redistributed, it's getting into the heel and
into the front of the foot. Another thing is cross training. If you're on your feet all
day running or walking, if you're going on long walks,
especially in the spring, try biking, try swimming, try doing Pilates at home, pushups, sit-ups, try hitting the gym and
doing some weightlifting.

That could really help out, especially while wearing the good shoes. But biking, swimming, all
that stuff, works so good. Now surgery. Here's where surgery
really comes in a place. For most people that I see, it's not really the lack of fat pad but it's the deformities. Like they have one really prominent bone that has arthritis and is not flexible, so sometimes shortening
or lengthening those bones can be very easy. Because the reality is with surgery, there are number one, silicone injections, and number two, fat pad harvesting. So fat pad harvesting is taking fat from one part of your body
and putting it into your feet. That fat can still move around because it's not natural fat
that grew up in that area, it's transplanted fat.

So it can scar, it doesn't hold as well. And the biggest problem is, what causes this fat pat to
disappear in the first place. It's probably gonna make it happen again very quickly within a year or two. That's what most studies show. That's the same thing with
the silicone injections, with the fake fat pad injections. People don't get rid of what
caused the fat pad to go away. So either too much
pressure or the deformity or too much bone, or maybe way more and your
muscles aren't as strong and you're putting too
much pressure on that fat, and it's squishing out of there, that's the big problem. Stretching and massage really help because it's not just the fat pad, but it's the ligaments underneath. So stretching can really help. One of the real problems
of fat pad atrophy is that there's too much pressure on the ball of the foot or the heel. So take a look here.

My right foot is more
flexible than my left foot, this is true for most people. It's usually one foot
hurts more than the other. So see how that one has to turn out, the left foot is turning out there. So look at the right
foot can turn up about 10 degrees more than the left foot. So there's a little bit
of a difference there. That difference right
there puts more pressure on the ball of the foot and
the heel of the left foot. It forces it to pronate,
which is turn out. See that awkward emotion. So what you wanna do is is you wanna increase that flexibility. So first part is icing and massaging, that makes muscles less
sore and more flexible. So I freeze a can here, but be careful not to make it explode.

These ice balls are really good, maybe not at the bottom of the foot. That's why I give it a thumbs down, but on the calf, on the hamstring, on the lower back they work well. These little spike balls are like a dollar at the Dollar Store, they're very effective in
massaging the plantar fascia, loosening it up, making
the foot work a lot better. So that gets a lot of the soreness, the stiffness out of there. And this is a massage roller
stick, I love these things. Now, they don't make
the fat pad grow back, but by massaging and
loosening the calf muscles, the back of the calf, the hamstrings, these take pressure off the foot, it makes your leg muscles absorb more. So see by making your muscles and your ligaments work better, you put less strength and less pressure on the bottom of your foot. So that's the ball of
your foot and your heel, there is more cushion
and now I'm stretching.

So stretching, same thing, it stretches your glutes, your hamstrings, your calf muscles. If you can't reach your toes, use a towel. I'm a big fan of using the
towel, it's very effective. So what that can do is
that can take pressure off the ball of the foot by
making that ankle more flexible. I love the slant board. So this is a measurable device. So it's gonna hurt with fat
pad atrophy being barefoot, so get some shoes and
orthotics that are soft. But see, you can start at 15 degrees, and as a week goes by
move it up to 20 degrees. As another week or two goes by, move it up to 25-30 degrees. And as that goes up, you gradually work your
way up to 45 degrees, and then I think that's 50
degrees on the final there, maybe 45 degrees that
works great, test it out.

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