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Psychologically disturbed children who bite and suck their fingers cause thickenings that resemble knuckle pads to occur in the skin in the traumatized areas. Patients with bulimia who use their knuckles or fingers to induce emesis sometimes develop fibrotic papules resembling knuckle pads. [8] Some cases of knuckle pads are familial.
Excessive pronation (rolling in) as increased pressure is put on the balls of the feet. Injury to the ball of the foot, multiple surgery incisions or fractures can lead to thinning and displacement of the fat pad. Genetics are considered to be a cause behind excessive loss of fat pads on feet. Rheumatoid arthritis, which causes clawing of the toes and more prominent bones in the balls of the feet.