Fat pad atrophy in ball of foot

The fat pad has atrophied in the ball of my foot to the point where the sesamoid bones are super tender. I can manage to climb in the gym as the holes are smoother and I climb for a short amount of time. However outside where the rock isn't as Steep and I'm putting more weight on my feet they get really painful. I've been using a little gel pad that I Loop over my toe which gives some cushioning on that part of the foot, just below the big toe. There's not a lot of room in climbing shoe to put something in. Wondering if anyone else has had this problem and come up with some solutions that have worked.

I have a different ball of foot problem, and have looked into this. You can get injections of sterilized human adipose fat tissue, or hyaluronic acid. They apparently work for a while, but I don't think they are permanent solutions. Otherwise, gel pads underfoot which can be a challenge for fitting into climbing shoes. You may have to get a different shoe to accomodate.

Sorry you're dealing with that — foot issues in climbing shoes seem especially hard to work around because there’s so little room to modify anything. Not sure if this applies, but it might be worth asking a sports podiatrist or physio whether a very thin dancer’s pad / sesamoid offloading pad could be trimmed specifically for your shoe setup. From what I’ve seen, some people also get better mileage out of a slightly stiffer shoe for outdoor climbing so the pressure isn’t all going straight into that spot. Did anyone mention whether taping or shoe choice could realistically offload it, or is it mostly a cushioning problem in your case?

(Responding from my husband's account)

Hi Jill,

I have been dealing with sesamoiditis/fractured sesamoid/atrophied fat pads for years. In my experience commercial pads and inserts just don't work for climbing shoes. The solution for me was to make my own "orthotics" to fit inside my climbing shoes. Also, the stiffer the shoe the better.

I trace the shape of the climbing shoe onto a drugstore insole and cut it out, trimming to ensure it fits snugly inside shoe. Then, I take more (thicker) insole material and cut a pad specifically shaped to relieve pressure on the sesamoid area. I glue this pad to the insole. Not the best for performance climbing, but better than no climbing.

Key for me was using custom orthotics 100% of the time in all other shoes and never going barefoot. 

Sue