Fat pad on top

When the bracing phase begins — that is, a few hours or days after removing the last cast and putting on the brace — a distinct little pad often appears on the top of the foot.
Doctors frequently (and mistakenly) call it swelling, and parents are understandably alarmed. So what is it actually?

FAT PAD

That little “puff” on the top of the foot is nothing more than a fat pad. It often causes concern among parents, many of whom start to panic, thinking it’s swelling.
What’s more — and quite commonly — many doctors also mistake it for swelling and tell parents to remove the brace, warning that it might “harm the child.” Nothing could be further from the truth!

IS IT SWELLING?

Swelling occurs when pressure inside the blood vessels increases, their permeability rises, or when there’s a reduced ability to keep fluids within the blood and lymphatic vessels. We can speak of true edema only when the skin is very tender to the touch, the “puff” feels firm and hard, is clearly painful, and appears bluish, reddish, or unusually warm. If none of these signs are present — it’s not swelling.

WHERE DOES THIS “PAD” ON THE TOP OF THE FOOT COME FROM?

The fat pad forms as a result of rapid accumulation of subcutaneous fat on the top of the foot due to the use of bracing shoes. Because the middle strap of the sandals is fastened quite tightly, the fat under the skin shifts forward, collecting toward the front of the foot.

This subcutaneous fat pad is soft and elastic — when you press it gently with your finger, it feels springy and flexible. In children with a COMPLEX CLUBFOOT, this pad is often much more pronounced at the beginning of the bracing phase, and it may even appear as if the “swelling” extends toward the toes.

SHOULD ANYTHING BE DONE ABOUT THIS “PUFF”?

Absolutely not. It is a completely normal phenomenon at the beginning of the bracing phase. The fat pad gradually decreases as the child grows and the foot develops — eventually, it simply disappears on its own.