HEEL PAD ATROPHY

Foot Pad Atrophy (PDF on what it is)

“In early 2026 I was training for a return to the Appalachian Trail. Over a three-year period, I had completed the Northern half of the Trail by hiking from Harper’s Ferry, VA to Mt. Katahdin. This would measure out at 1,878km. The Southern half of the trail would add another 1,645km.
Training for this had me wearing 10kg of back pack and walking up and over. PKOLS (Mt. Doug) in Victoria.

It was after one of these training hikes that I developed a painful left heel that seemed to be centered on the bottom of that heel. I visited ‘Dr. Google’ and came up with the advice to ‘RICE’ (Rest. Ice. Compression [there was no swelling of my heel] and Elevation for ‘Conservative’ treatment. I figure I had just bruised my heel with my training hikes.

After a week of this home brewed therapy my pain was not lessening one iota. I made an appointment with physical therapist (who was also a Chiropractic physician) to present my case. She diagnosed Plantar Fasciitis and added to my Conservative home treatment the intervention of ultra sonic ‘Shockwave Therapy’. My research online I found this rather painful treatment does accelerate the healing of the inflammation on the bottom of the foot. In my case, after five courses of treatment with the Shockwave device my pain did not resolve.

By now, three months had passed and the pain had not lessened. I was finally accepted by a DPM (Doctor of Podiatric medicine). At my first appointment he provided a new diagnosis of ‘Heel (fat) pad atrophy. In other words, what with aging and my history of long distance hiking the cushioning of where the heel strikes the ground resulted in a chronic loss in the fat pad thickness was allowing the ‘trauma’ of walking (let alone hiking with a 15kg pack over 30km a day for five months) to cause me pain. His diagnosis led to a treatment plan of continued Conservative treatment and the addition of a silicone ‘heel cup’ in my shoe to ‘off weight’ my heel.

Having been a RN for 45 years and with 10 years of experience as a certified Wound Care Nurse a tickler memory popped up from my memory. I recalled a treatment for thinning fat pads in the foot among diabetic patients by injecting the foot with an ‘allograft’ (the patient’s own fat tissue removed from another site on the body). So, off I was to the internet portal for the Cleveland Clinic ⁽¹⁾. This was a reputable website for medical advice that I gotten from my oncologist years earlier.

Diving into the website I did find an essay on Heel Pad Atrophy and a listing/discussion of treatments for the painful condition. I was pleased that the tickler file from my memory was correct and than the allograft treatment was listed as a potential intervention. What really caught my eye was the use (in clinical studies) of ‘dermal filler’ (often used for cosmetic procedures in the face) had been studied with good outcomes for heel pain caused by Fat Pad Atrophy ^(2-7).

Comforted by the literature I sought out a provider who was familiar with the procedure and skilled in carrying treatment using a dermal filler.
After multiple phone calls to clinics offering dermal fillers (mostly for cosmetic procedures) I found the practice of Dr. Anna Sylwestrowicz, MD ⁽⁸⁾. The office was very accommodating with my unique inquiry and agreed to meet with me just to discuss my diagnosis and treatment plan.

One of the most vital requirements for a good medical outcome is a solid ‘Doctor-Patient’ relationship that starts with an open and frank discussion. I found my conversation with Dr. Anna (as she prefers to be addressed) to be all a patient could ask for. We jointly came up with a plan, discussed the various dermal fillers on the market, her experience with their use, possible outcomes and hoped for outcomes. I agreed to the procedure.

Three weeks before the start of my hike, Dr. Anna injected my left heel pad with dermal filler. The procedure itself was tolerable and I walk out of the office with an order to ‘take it easy’ with my walking. For the first 5-6 days I was sore at the injection site but that was too be expected. After a week, I restarted my daily dog walks (much to the pleasure of our Doodle) and gradually increased my mileage.

On April 23rd, 2026 I found my self hiking south on the Appalachian Trail from the small village of Damascus, Virginia. I was planned on keeping my daily mileage under 20km while carrying 15kg of pack. At that point, my heel was pain free.

I hiked for a month pain free. I ended this section of the Trail in the very tourist town of Gatlinburg, Tennessee. This was a distance of 400km-pain free!

Considering the pain, I was in prior to the injection of dermal filler this was a remarkable medical outcome. I am very, very pleased.

As for the future, there are 333km left for me to complete. I will be back to the Trail in September for finish that section.

Thank you to Dr. Anna and her staff in joining me on this journey!”

References:

1. Anon., Heel Fat Pad Syndrome, Cleveland Clinic website, 06/14/2022, https://my.clevelandclinic.org/health/diseases/23275-heel-fat-pad-syndrome, Accessed 26 May 2026.
2. Gold, Jodi, Pilot Study: Fat Pad Restoration With Adipose Allograft in Metatarsalgia Patients Shows Structural, Functional Improvement Pilot Study Plast Reconstr Surg Glob Open. 2025 Dec 3;13(12):e7336, doi: 0000000000007336 https://pmc.ncbi.nlm.nih.gov/articles/PMC12674145/ Accessed: 26 May 2026.
3. Bcharah, G., et al, Fat grafting for pedal fat pad atrophy: A narrative review of the literature The Journal of Foot and Ankle Surgery Volume 64, Issue 6, November–December 2025, Pages 835-842 https:/do.org/10.1053/j.jras.2025.07.008 Accessed 26 May 2026.
4. Ko, Seung, Kim, Bomsoo. Short-term clinical outcomes of cross-linked hyaluronic acid filler injection in the treatment of plantar fat-pad atrophy syndrome J Foot Ankle Surg 2026 Jan-Feb; doi: 10.1053/j.jfas.2025.07.004. Epub 2025 Jul 9., https://pubmed.ncbi.nlm.nih.gov/40645399/ Accessed 26 May 2026.
5. Gusenoff, J., Autologous Fat Grafting for Pedal Fat Pad Atrophy: A Prospective Randomized Clinical Trial, Plast Reconstr Surg 2016 Nov; 138(5): 1009-1108, https://pubmed.ncbi.nlm.nih.gov/40645399/, doi: 10.1097/PRS.0000000000002667, https://pubmed.ncbi.nlm.nih.gov/27391833/ Accessed 26 May 2026.
6. Wu, B., et al, A New Minimally Invasive Procedure for Treating Plantar Heel Pain Stromal Vascular Fraction Gel Grafting, Annals of Plastic Surgery 91(5):p 609-613, November 2023. | DOI:10.1097/SAP.000000000000365, https://journals.lww.com/annalsplasticsurgery/fulltext/2023/11000/a_new_minimally_invasive_procedure_for_treating.19.aspx, Accessed 26 May 2026.
7. Miller, A., Filler in the foot: treatment of plantar fat pad atrophy with dermal fillers, J Aesthetic Nsg, Supplement, 2020 March, https://www.medicalaestheticsacademy.org/wp-content/uploads/2021/02/Filler-in-the-foot.pdf, Accessed 26 May 2026.
8. Dr. Anna Medical Aesthetics, https://drannamd.com, 1964 Fort St, Victoria BC V8R 6R3, (250) 590-0883

Additional References:

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