Fat Atrophy in the Foot and Foot Injectable Supplements
- David Tollafield
- Aug 17
- 5 min read
Updated: Sep 23
Understanding Metatarsalgia Due to Fat Atrophy
I find it alarming that some patients feel desperate enough to take significant risks for foot health. While I respect an individual’s right to choose, it’s essential to consider the critical factors associated with fat replacement in the foot. This is especially relevant when discussing a common cause of metatarsalgia.
In this article, I will cover:
The need for caution regarding fat-supplemental injections.
The primary causes of metatarsal fat atrophy in the foot.
My conclusion and professional opinion.
Caution and Medical Evidence
Just because a foot doctor claims to have performed numerous procedures without incident does not mean the method is endorsed by a professional body. If the person offering treatment is not qualified, registered, or lacks an officially recognised professional body, proceed with caution. Registration bodies exist to protect patients, and their standards can vary between the UK and the USA.
While I wouldn’t suggest that the doctor or health professional is untrained or incompetent, I urge you to recognise the importance of established treatment pathways. This means relying on scientific evidence and ethical support for any licensed product, ensuring proper patient consent.
The Importance of Ethics in Treatment
First and foremost, do not assume you have exhausted all options. Avoid entering into a contract that requires you to consent to a treatment that does not meet established standards. Here are two critical questions to consider:
Is the treatment recognised as safe?
Who has recognised the treatment?
Professional bodies
Independent authors
Registration bodies
Drug and medicine agencies
Peer review
If these criteria are not met, do not proceed.
In the past, we often experimented with new ideas, sometimes promised by manufacturers. Today, the importance of ethics and approval by an Ethics Committee cannot be overstated. An Ethics Committee will only approve a product if it is deemed safe and has passed all necessary steps to protect each patient involved in a study. Once ethical approval is granted, research can begin, and a paper trail will document all considerations in the study.
A scientific study requires a comparison point, such as a neutral effect or a placebo. For instance, a foam insole or pad could serve as a placebo. The key question is whether the new treatment will outperform it or behave no more effectively than the foam insert used for fat replacement under the ball of the foot.
Although small in size, the trial will test the effectiveness of the product over a designated period. In the case of injectable silicone for painful corns, we followed this for years but published results after one year. The placebo was sterile water, and silicone fared no better than water. These results allowed us to conclude that the evidence supported the non-use of silicone injectables for corns, let alone fat replacement.
The Need for Further Research
Further research is essential. For any product to be successful, additional studies involving larger numbers are required, replicating the original trial and learning from any material problems.
Fat replacement has been attempted with various products. To ensure safety, it must adhere to all previously mentioned criteria. Follow-up should occur for a minimum of five years, with all side effects published. Research results should be shared with patients objectively, and alternative methods discussed.
Many patients believe they cannot get any worse and opt for a treatment. Unfortunately, not only may the product fail to work, but the foot problem can also deteriorate, leading to permanent disability.
There is no risk-free treatment for atrophic fat pad problems.
Primary Causes of Fat Pad Atrophy in Feet
The metatarsal ends are enlarged. The toe end forms a rounded (elliptical) shape and, with the exception of the first metatarsal, sits on a cartilage disc or plate. This acts somewhat like a ski shoe, reducing pressure and allowing the toe joint to function smoothly. However, fat is still required to add to that important cushioning effect.
Loss of fat typically occurs due to two critical features: foot deformity around the joint between the metatarsals and phalanges (toe bones) and ageing.
Lipo (fat) atrophy (wasting) differs from lipodystrophy. The latter condition has more medical-based causes, but some medical conditions can exacerbate fat wasting under the ball of the foot and heels. Heel pain and bruising differ from fat atrophy under the metatarsals.
Rheumatoid arthritis and some autoimmune diseases can lead to wasting of the fat pad. This includes motor neuron diseases. Endocrine diseases, such as hyperthyroidism, can cause general wasting and weight loss.
Injection-induced wasting can occur from multiple steroid injections.
Genetic predisposition to fat loss may run in families.
Previous surgery under the foot, such as excision of bursae or cyst-like masses, can also contribute.
Toe Deformity and Dislocation
The metatarsophalangeal joint is sensitive to any deformity. When the toes are hammered or retracted, the fat pad shifts forward, exposing the metatarsal head and its ability to take and distribute pressure.
A congenital high arch foot can also lead to higher foot pressure and fat pad wasting as the fat pad shifts forward.
Conclusion & Professional Opinion
Currently, there is no implant or injectable agent that can effectively replace fat. Surgical methods of injecting fat have been tried, but they can lead to additional wasting. I, along with others, have thoroughly investigated the work of Sol Balkin and injectable silicone. The story is detailed on this website, and the paper was published by Foot & Ankle Surgery80065-X/abstract).
Patients can enter registered trials if they meet all the conditions mentioned above, but health professionals must also protect patients from charlatans.
Fat pad loss is undeniably painful and can significantly affect quality of life. The key to most foot problems is selecting the right footwear, which includes the materials used for the sole, insole, and design. Sock absorbing properties are essential, and the design must allow for a good fit without pinching across the forefoot, as seen in some ladies' shoes. Above all, the heel should be as low as possible.
Supplemental padding can be provided through metatarsal pads, prescription insoles, or orthotics. The use of gel and silicone materials has significantly improved comfort compared to older rubber and foam plastic materials.
If all else fails, a foot surgical specialist (orthopaedist or podiatrist) will assess toe deformities and consider specific procedures. If the fat pad problem arises from surgery, salvage surgery may be required using osteotomies, where the metatarsals are altered to reduce pressure. Such procedures are last-resort treatments, and I have resorted to them in cases where a patient's quality of life is seriously affected. By far, the best management method remains appropriate footwear and orthoses.
The notion that people cannot be made worse is far from true. Desperate individuals may go to any lengths, and a promise made can easily override any sense of impending danger.
Thanks for reading 'Fat Atrophy in the Foot and Foot Injectable Supplements' by David R. Tollafield.
