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Fat pad changes with high BMI

Discussion in 'General Issues and Discussion Forum' started by Sara Arenson, Sep 17, 2018.

  1. Sara Arenson

    Sara Arenson Welcome New Poster

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    Hi everyone,

    I'm a patient, not a podiatrist, but I found this forum and it looks really helpful, so I thought I'd see what you thought of my problem.

    For 4.5 years, I've had bilateral foot pain, starting in the outer back edges of my heels but eventually spreading everywhere. It gets worse the longer I stand, and feels better almost right away after I get off my feet - then bad again as soon as I stand. The feeling is a deep achiness, and it's worse when I stand still, a bit better when I walk. Because of it, I can't stand long enough to work at many jobs. On a good day I'm on my feet for maybe 2 hours. The pain started a couple months into a job standing on concrete floor for about 25 hours a week.

    I was misdiagnosed with plantar fasciitis a few times, then someone suggested heel fat pad syndrome (atrophy), but both custom orthotics (hard plastic) and heel cups weren't comfortable. The only shoes that seem to make it better are my Dawgs (like Crocs). My regular running shoes (New Balance) with Powerstep Pinnacle insoles, lead to pain pretty quickly.

    After all these years of not getting anywhere, I finally saw a podiatrist who has Doppler ultrasound. He said he had a theory based on my symptom description, but then he actually looked into my feet to confirm it.

    This is what he found: my heel fat pads have become more dense with fibres like collagen, consistent with what happens with people who have a high BMI. There is no atrophy, however. Therefore, he said, they can't absorb shock well and I am feeling bone pain. He even conjectured that the bone pain could be calcaneal bone odoema. He said he's seen this problem in others with high BMI. He also said my gait looked normal, so he wasn't thinking in terms of alignment issues.

    I was very bummed when I heard the news. I used to be slim, before some medications put 80 lbs on me, making me 225 lbs and 5'6" (thought I was about 200 lbs when the problems started) and even though I watch what I eat and sign up for several exercise classes a session (despite foot pain), I can't seem to lose the weight. Also, I know people who are heavier than me and seem to have no problems at all. I just can't understand, why would MY heel fat pads become dense like that? And why can't my bones handle it?

    So I'm trying to figure out what to do. I've agreed to his recommendation for custom orthotics that will provide more cushioning and spread out the pressure evenly, as well as having a gel insert in the heels. I have a few Dr. Scholl's gel products I'm experimenting with while waiting on the custom orthotics. Ironically, he also told me that my Dawgs probably are helping me, because they have so much cushioning, and that's the issue here.

    He also mentioned losing weight, but it's kind of hard when it's so hard to stand, and these meds still make it almost impossible. I consider it a victory that in the past 2 years I finally stopped gaining weight. So that's something to keep trying, but there's no guarantee. And besides, he said there were no studies that showed whether the fat pad returns to normal after weight loss.

    I keep trying to picture what might be going on in my heels, but I don't have the medical background. I keep wishing there was some way of softening or re-elasticizing my heel fat pads. Can I soak them in something? Is there a cream that will help? Is there a kind of massage? Like should I be breaking up tissue? Or will that make the fat pads less durable?

    I also wonder, why are my bones so sensitive? Is there something wrong with them? Do they need strengthening? Should I be requesting any additional tests to look at them, e.g. MRI?

    There's also the question of, how come people much bigger than me have healthy feet? What other factors could be making the pressure down there worse? I know that I have very, very tight muscles and fascia all over.

    At this point I'm quite demoralized by this situation. I'd like to better understand this condition, which I can't seem to find described anywhere - it's not PF (demonstrated on ultrasound), it's not heel fat pad atrophy, it's not a bone spur (though I do happen to have a little one on one foot), it's this other thing that I'd never heard of before the podiatrist showed me. As far as I know, there isn't even a name for it.

    Does this situation ring any bells for you folks? Is there anything you could suggest? I would ask the local podiatrist more questions but I feel like he's already been very generous with his time.


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