Hi everyone,
My sfn continues marching in slowly but relentlessly.
I thought it related to alcohol consumption but now
no longer bother, 18 months without a glass of wine).
As it’s worsened I’m assuming it’s something else.

The pain in my feet has a new, and difficult to deal with
component - fat pad atrophy, so I can feel some of the bones
of my feet through my skin. It’s really painful walking after
a very short distance. Along with this I also have the wrinkled
fingertips with reduced pulp. It makes handling keys for example
quite painful.

Is this a common complaint and does anyone know of a solution, especially
for the feet. I miss my hiking days.

Keith,
If it wasn't for a great orthotist and the custom orthotics he shapes from plaster foam box impressions, I'd be SOL! Combine these orthotics with a pair of New Balance 857 high support cross-training shoes and I'm good to go. This formula has served me well for the past 12 years.

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This information about fat pad atrophy may help Treating Fat Pad Atrophy | Podiatry Today .

I have not come across a link between it and PN.

Thanks Kiwi. No I haven’t either. I have it though, developed fairly recently. I’ve had sfn for two years. My neurologist didn’t seem to know much about it. I did read that article you linked to. Like sfn itself, there isn’t a lot of information. Type in to google Crohns disease (my other illness) and you’d be there for months reading it! Thanks again though.

Thanks for your post KMB Sorefeet! I have the same symptoms as you...its very painful to walk or stand for any amount of time. it fells like i am walking on broken bones. I have large fiber peripheral neuropathy fo 18 years now. the broken bones feeling started a few years into it. I have mentioned it to neurologists and lately neurosarcoidosis experts and no one had an explanation. looking at my own feet it looks like my fat pads may have atrophied too. i will have to look into this. i dont know if anything can be done, but it would be good to know why walking and standing is so painful. thanks again!

Hi there. Thanks for your reply. In the middle of my forefoot is where I can feel the shape of bone underneath the skin. There should be all least 1cm of padding provided by fat within a collagen framework. Apparently. As Joe said, there are orthotics that can help a lot. Basically by providing the padding and force distribution that you have lost. There is also a procedure I’ve read about that involves rebuilding the matrix using transferred fat. Not sure how common that it’s though. Mine neuropathy is small fibre (probably) the neurologist hasn’t actually been able to provide a definitive diagnosis. It seems to be one of exclusion. Good luck.

Thanks Joe. They look impressive. I saw a podiatrist recently who hasn’t so far helped. Do you have problems with thinned fat pads too? Do you think it’s related to neuropathy?

Yes, I've struggled with plantar fat pad atrophy for about thirteen years. I went to a highly rated orthopedic surgeon in my area, who diagnosed me with high arches and plantar fat pad atrophy.

He referred me to an amazing orthotist who has fitted me yearly with fresh, updated orthotics. He analyzes the wear patterns (indentations) on the previous orthotics before adjusting the shape and off-loading characteristics of the new ones.

They're rather expensive, but fortunately my insurance covers the cost.

Keith, my recommendation to you would be to stay away from podiatrists. Traditionally, all they will do is inject you with Cortizone and sell you ridiculously overpriced and totally ineffective supplements for your neuropathy.

BTW, Cortizone injections can lead to further soft tissue degeneration.

Hi Joe, that’s a really useful insight which I appreciate. I’m going to see my gp on Wednesday so I’ll ask for a referral to a surgeon. Luckily the company for whom I work provide a good level of insurance which means I can get a quick appointment. I’ve been reading a bit about ulcers in the neoropathic foot and it seems I’m at risk of that. Your long term strategy gives me hope. I miss hiking, it would be great to have another opportunity to do that.