Forefoot plantar fat pad

gabenstein

Barefooters
Jun 28, 2011
9
0
1
Doctors-

I have been trying to break in very slowly to barefoot running. I had a massage therapist comment that I didn't have a lot of padding over my metatarsal heads in my forefoot once when massaging my feet. Does this mean that I shouldn't run barefoot? Also, is there any evidence that the fat pad hypertrophies, thickens, or adapts in any positive way to the stress of barefoot running (if introduced properly)? I have seen on other medical sites that walking/standing barefoot leads to atrophy of the fat pad, so I'm a bit confused by all that. Any thoughts?

Thanks.

Jon
 
Welcome Jon! I am not a doc,

Welcome Jon! I am not a doc, but I will throw in a comment while you are waiting for someone better to get back to you.

I have no clue, frankly, about the relative thickness of the fat pad before and after some program of barefoot activity. If there is actually published evidence about the change in this piece of anatomy due to barefoot activity, I'd be interested in reading it. I have read on internet bulletin boards that lack of a fat pad can be painful. Now I am assuming you are not in pain, but just concerned if your body can adapt. If this is the case, you might consider that in my experience adapting to barefoot activity involves much of your body -- it will change your posture, the way you step etc. Padding or toughness is not the only change, or even the main change. Watch any experienced barefoot runner and you can see they move in totally different way than a shod runner: they do NOT merely have more padding on their feet. Their feet aren't so much "protected" by padding as they are passing information to the rest of the body about how to move. Just my 2 nonprofessional cents. :)
 
Thanks for your input.  I

Thanks for your input. I developed ITBS about 4 years ago. After suffering for months, I changed my running style, in shoes, to a forefoot/midfoot strike. Sometime in that next year I developed metatarsalgia, which put me out for months. With a well placed metatarsal pad I started running again and was doing exceptionally well until last fall when it started bothering me again, with the addition of bilateral pain at the 5th metatarsal head on the outside and underneath it. I had to completely stop running for months. I figured what I was doing didn't work, so I thought I'd try ditching the shoes. Most people think that is completely insane, since I was having so many foot problems IN shoes, particularly with my forefoot. But, like I said, what I was doing wasn't working. Unfortunately, I got a little overzealous in VFF's 10 days ago and did 10 minutes on asphalt. I had only done maybe 3 minutes at a time prior to that barefoot. Stupid, stupid, stupid. Lit up both forefeet/metatarsal head areas. I am just afraid that I will hurt myself with my foot problems trying further with BFR. I saw a post referenced by one of the docs about "are you ready for barefoot running," though I could not find it.



Anyway, sorry for the novella. I'm tired of being hurt, and I want to be able to run until I'm old, Lord willing I live that long. Pretty sure there is no way that will happen unless I learn to run "softer."

Thanks for the warm welcome.

Jon
 
Wow, what a mess of trouble! 

Wow, what a mess of trouble! Sorry to hear about it. I'm sure more people will be along here to commiserate and advise you, but it's the holiday weekend so it might take longer than usual. In the meantime be careful with fireworks...
 
The docs should be along soon

The docs should be along soon to answer your questions about fat pads and everything else.

In the meantime, I'm wondering if you've actually tried to run, say 5 minutes completely barefoot. It could be that you are relying on the shoes (VFFs) to do the work for you, assuming they are protecting you in some way, and running harder and pushing off with your forefoot, instead of lifting as you should be doing. If you remove the layer between you and the ground, I bet you will run much, much more softly. Give it a try and let us know how it goes. Only run no more than 5 minutes barefoot for that day though. Run on a hard, smooth surface free of debris, such as concrete or asphalt, no gravel. (Although gravel is a great teacher to new barefoot runners, right now, you don't need to deal with that, not until you are sure you don't have some other serious foot problem going on.) Do not run at all in shoes that day. Be sure your feet are feeling relatively well when you do so. Then wait a good 24 hours at least to assess how you did, since some pain doesn't show up until later. If you find you are still having the same problem, then perhaps one of the docs here can help. If you find it went relatively well, then perhaps you were running to hard and pushing off in the VFFs.

Good luck and welcome!
 
Thanks for your suggestion. 

Thanks for your suggestion. Knowing my feet, I better start off with 2-3 minutes on the hard surface and build up from there. We'll see how it goes. The input is much appreciated.

Jon
 
Good you follow your own

Good you follow your own body's advice. I will be standing by waiting for an update.
 
Jon, From my experience and

Jon,



From my experience and seeing barefoot runners...of course the fat pads hypertrophy. the gradual stimulus develops the fats pads. My feet are way thicker now and there are fat pads where the contact points on the ground are, esp the base of the 5th metatarsal. Process takes months.



Trying to figure out how to paste pic but that is my foot on the scrolling pictures on home page with Natural Running Center.



Dr. Mark
 
Yeah, I'm not a doctor or

Yeah, I'm not a doctor or anything, and I suppose I don't know about any "fat pad" but the skin pad on the bottom of your foot will definitely thicken. I have a good quarter inch of skin on the ball of my foot, which is certainly far more than your average shoddy. And I'm not even running actively right now.

But Stomper is right, while you will experience thickening of the foot skin, most of what you need is changes in form that will allow you to run much more gently. It takes time, and the only real way to learn is to get out and run with no shoes on. Your body will figure it out eventually if you let it.
 
Naked Doc and Danjo-Thanks

Naked Doc and Danjo-

Thanks so much for the input. It is very much appreciated. Tough to be patient and allow the feet to get conditioned. I'm sure that is why so many folks get hurt trying to run barefoot. I don't want to be the next so I'm trying to be smart and listen to my body a bit more than normal.

jon
 
What about fat injections,

What about fat injections, like they do in plastic surgery? Is that a stupid thought?
 
Would a loss of overall body

Would a loss of overall body fat affect the foot pad as well? And would say a 4% drop of body fat mean that same ratio in the foot pad?
 
I'll echo the comments about

I'll echo the comments about form. I also have a thin fat pad and really felt it when I first kicked off the VFF's... for me the key was form form form. And at 250lbs, especally focused on active lifting of the foot, or the image of starting to lift before the foot is even placed. It's keey to running gently.



It's worked for me at least
 
I think this needs to be

I think this needs to be studied. It seems to me that my pads are getting thicker since starting to run barefoot, and I have heard this from others.



And it is a known phenomenon that is studied and measured in horses. They develop a thicker sole during their transition from shoes to healthy barefoot living. This is one of the signs of success, as greater sole grows to protect the bones.
 
I'd like to know more too.

I'd like to know more too.
 
gabenstein wrote:Thanks for

gabenstein said:
Thanks for your input. I developed ITBS about 4 years ago. After suffering for months, I changed my running style, in shoes, to a forefoot/midfoot strike. Sometime in that next year I developed metatarsalgia, which put me out for months. With a well placed metatarsal pad I started running again and was doing exceptionally well until last fall when it started bothering me again, with the addition of bilateral pain at the 5th metatarsal head on the outside and underneath it. I had to completely stop running for months. I figured what I was doing didn't work, so I thought I'd try ditching the shoes. Most people think that is completely insane, since I was having so many foot problems IN shoes, particularly with my forefoot. But, like I said, what I was doing wasn't working. Unfortunately, I got a little overzealous in VFF's 10 days ago and did 10 minutes on asphalt. I had only done maybe 3 minutes at a time prior to that barefoot. Stupid, stupid, stupid. Lit up both forefeet/metatarsal head areas. I am just afraid that I will hurt myself with my foot problems trying further with BFR. I saw a post referenced by one of the docs about "are you ready for barefoot running," though I could not find it.



Anyway, sorry for the novella. I'm tired of being hurt, and I want to be able to run until I'm old, Lord willing I live that long. Pretty sure there is no way that will happen unless I learn to run "softer."



True. What you describe tells me you, from my personal experience going thru it and just starting to come out of it, were hitting the ground way too hard all those years. Even in shoes. Most likely more so when you switched to forefoot/midfoot, in shoes. Ditch the footwear completely, unless weather and circumstances absolutely prevent it, and start from scratch barefoot. It's what I did and I still have some minor aches and pains but nothing near what I did. Hell, the one hot spot on the 2nd metahead area bothers me more (when I screw up and agitate it) when walking than when BFRing.



Start with short distances and for the love of running don't run on the balls of your feet, ever, and please try to not run in those minimalist shoes. You're really gonna be pissed at yourself if you fracture something. Some folks can deal with it; YOU (and me) should never do it until years from now :)



Go for a mid foot strike while barefoot and allow your bent knees and legs to absorb the impact. Don't go any farther than 1km your first time, perhaps less if you start to feel the skin. Keep those calve mucles loose and lengethen, go easy on them. It will take months for you to build enough to a weekly routine and even then you'll likely not be a "normal" speed or distance for months after that. You're essentially starting all over again. Good luck and keep those metaheads iced when they are agitated and give yourself time in between to allow for regeneration.



hope one of the docs can give you some insight on your other issues!
 
Man, I really appreciate all

Man, I really appreciate all the thoughtful comments that you all have been giving.

Here is what I have been doing. #1 I have been trying to live barefoot, in invisible shoes, or in vibrams as much as possible. I am a surgeon on my feet operating for long periods of time, and while I really do well barefoot or minimalist when moving I find that standing on tile floors for hours makes my feet hurt. I don't know if they are just not used to it or if it isn't good to STAND for that long barefoot. I have seen on some podiatry sites that going barefoot causes fat pad atrophy. This really makes no sense to me since, in general, the body's response to a stress is hypertrophy, not atrophy. Also, if this were the case, no one in a barefoot culture would have a fat pad. I suspect there is virtually no data to back up the statement that going barefoot causes fad pad atrophy. Likewise, there is no clinical data to my knowledge to support my theory that it would be more likely to hypertrophy due to controlled stresses of going barefoot. Anyway, I digress.



#2 I am doing all sorts of foot strengthening exercises to try and work on any muscle imbalances in my foot. Lee Saxby's videos on VIVOBAREFOOT's website have been helpful. I have been gradually increasing the amount of repetitions with barefoot hopping and jumping rope. I don't really plan on trying to run until I can jump rope barefoot comfortably for 10 minutes or so and can do single foot jump rope for 25-50 repetitions at a time with each foot. Does that make sense to anyone? Anyone have 2 cents to add?



I'll throw a question/issue out there for one of the docs

Fat pad augmentation with autolipotransplantation (taking fat from one area and putting it at the fat pad) or collagen fillers or silicone last only a short period of time; however, there are podiatrists doing fat pad augmentation with graft jacket or perhaps other biologic materials made from human dermis. There is limited clinical data on this to my knowledge but I would appreciate anyone elses input. It seems to make some sense.



Question for all-

Is it normal for me to have plantar soreness with all of this barefoot activity and how long does it take to go away. I have been "living barefoot" or in minimalist footwear for about a month. Am I just being impatient?



Thanks everyone.

Jon
 
Too much too soon can also

Too much too soon can also apply to all the various forms of exercise for the feet as well. I never really do those exercises as I tend to think the best way to adapt to barefoot running is to run barefoot and cease wearing support foot wear. On really, really bad days when my form wasn't so good and my left 2nd metahead is tender, I"ll wear my zero drop keens which are more flexible than normal shoes with a wide toe box and zero support. They have just enough protection that I relax into them and allow the foot to heal faster.

From what I've read about most other BF runners; the "norm" is hard to pin down. Without fail, everyone has to slow down in speed and distance for weeks until the soft tissue and bones adapt enough to form a weekly BFR routine. Some do the various strength training and others just run barefoot and ditch the supportive foot wear. A small percentage of the folks have similar issues to what you and I are experiencing with the good news being that it will eventually stabilize to the degree where you should not notice it.

In all cases of folks that stuck with BFR for a year or so, things do work themselves out regardless. If I were you, I would focus more on proper form and getting naked feet to concrete to get that skin adaptation going.

Three things that helped me a lot:
1.) stretch, stretch, stretch (CAREFULLY and less so on your running days!). If you can't touch your toes, start working on that. I can give you some details if you want but the most important thing is to not allow those muscles to stay chronically short. To that:

2.) Trigger points and mayo fascial massage. Some of your soft tissue issues may be caused by chronic muscle tension/shortening at various points in your legs. I spent a few hundred dollars on medical texts and toys on the matter and it helps quite a bit.

3.) Don't go crazy with all those foot exercises; it's more important to learn the "place foot lightly" form and learn to stay relaxed while running.

TIP: If you find that "babying" a chronic issue isn't helping, stop babying it and use it more so long as the pain doesn't prevent it and there is no major damage to the connective tissue and the bone structure. I've found that a little push beyond a perceived limit does wonders but it needs to be done with discernment and caution. Most importantly, don't get angry or frustrated. The body doesn't do so well with that :)

Good luck. Your journey is likely to be more difficult than most, mine was and still is due to connective tissue issues, but with time and an open mind, you'll adapt and find yourself running a weekly routine without shoes.
 
Jon, is your jump rope

Jon,



is your jump rope leather? if so i think your crazy to do it bf. i've tried and it hurts. unless you're better at it than me. i wear kso's now when i do it. if you're going to do it i wouldn't worry about reaching any goal, but just doing it. your feet hurt from standing because they aren't use to working so much. even though i've been running bf for over a year my feet hurt when just standing in shoes. i wait tables so i have to wear shoes to work, Merrell Tough Gloves. i heel strike in them which is uncomfortable but they may be the best option i have unless i can get some very nice looking soft stars. so i can work without foot pain unless i'm just standing around. just try bending your knees and shifting your weight.



i get the feeling you're type A. you're going to have to learn to relax and be patient on your bf journey otherwise you WILL hurt yourself. give your body proper rest. don't over do it. if you don't rest then your body may get injured or sick to force you to rest.



good luck,



Mike
 
gabenstein wrote:Question for

gabenstein said:
Question for all-Is it normal for me to have plantar soreness with all of this barefoot activity and how long does it take to go away. I have been "living barefoot" or in minimalist footwear for about a month. Am I just being impatient?

I am inclined to think that the soreness you feel standing all day on a flat artificial concrete/tile surface is actually due to the uniformity rather than a weakness of your feet. It is like running a marathon, after a few hours of running it is very difficult to move your body in other ways than running, like a simple forward bend. Basically overuse of a few muscles in your feet.