Heel Fat Pad Syndrome

What is heel fat pad syndrome?

Heel fat pad syndrome is the thinning of the fat pad on your heel.

Your heel pad is made up of fatty tissue and thick elastic muscle fibers. Your fat pad acts as a shock absorber or cushion and a protector of your heel as you walk, run and jump. Over time, too much wear and tear on your heel pad and other factors cause the fatty tissue to shrink or cause the heel pad tissue to lose its elasticity. The result is heel pain that can interfere with your daily routine and activities.

Heel fat pad syndrome is also known as fat pad atrophy, fat pad syndrome and heel fat pad atrophy.

How common is heel fat pad atrophy?

Heel fat pad atrophy is considered the second leading cause of plantar heel pain after plantar fasciitis. Heel fat pad syndrome is often misdiagnosed as plantar fasciitis.

What are the symptoms of heel pad syndrome?

Symptoms of heel pad syndrome include:

• Deep pain or bruise-like pain in the middle of your heel when you walk, stand or run.
• Deep pain that can be reproduced with a firm press to the middle of your heel.
• Pain that increases in severity when standing or walking for long periods, while involved in high-impact exercises or activities (jumping, running, gymnastics, basketball) and when barefoot and walking on hard surfaces (hardwood floors, concrete, ceramic tiles).

Mild cases may not have symptoms or you may only notice occasional pain when walking barefoot or on a hard surface, running or when pressing your fingers into the middle of your heel.

What causes heel pad syndrome?

Heel fat pad syndrome is a wear and tear condition. Many factors contribute to it, including:

• Increasing age. Your heel loses some of its fatty tissue and elasticity as you age.
• Increased body weight. An increase in your body weight increases the pressure on your heel pad, causing a faster loss of elasticity and the cushioning properties of your heel pad.
• Family history. A family history of heel fat syndrome or medical conditions that affect connective tissue or cause inflammation can increase your risk of developing heel fat pad syndrome.
• Trauma to your heel pad. Injury to your heel pad from a direct hit to your heel can lead to heel pad syndrome.
• Gait imbalance. How you walk (your gait) — how the parts of your feet touch the ground and distribute your weight — affects how your heel pad may wear down over time.
• Foot structure. The alignment of the arch of your foot to your foot’s upright position along with an abnormal gait can add pressure to your heel pad.
• Inappropriate footwear. Not wearing shoes or footwear that properly absorbs the impact of repetitive stepping on your heel causes your heel to bear the brunt of steps and leads to loss of the heel pad.
• Hard surfaces. Walking or running barefoot on hard surfaces, such as concrete or tile, can increase the impact on the fat pad on your heels and cause thinning and straining of the pad tissue.
• Repetitive activities. Engaging in activities in which your heels repeatedly pound the ground or standing for long periods can lead to wear and tear and inflammation of your heels. High-impact activities may include basketball, tennis, volleyball, running and gymnastics.
• Previous corticosteroid injections. A breakdown or shrinkage of the heel pad is a side effect of corticosteroid injections, which are used to treat pain and inflammation in other foot conditions. Repeated steroid injections into the heel have also been demonstrated to increase the risk of the fat pad breaking down.

Medical conditions that contribute to the development of heel fat pad syndrome include:

• Plantar fasciitis. This condition is inflammation of the plantar fascia ligament that connects your toes to your heel. The condition can cause heel pain.
• Heel spurs. Heel spurs can contribute to heel pain by reducing heel pad elasticity through the straining of your foot ligaments.
• High arch feet. This condition can permanently change your foot structure and affect the ligaments in your feet, leading to heel fat pad syndrome.
• Type 2 diabetes. This disease can break down fat and collagen in your fat pad.
• Lupus and rheumatoid arthritis. These diseases can affect connective tissue, including connective tissue in your feet.

How is heel fat pad syndrome diagnosed?

Your healthcare provider will ask about your medical history and your current symptoms.

Your provider will ask you detailed questions about your heel pain including:

• How the pain feels?
• When do you feel the pain?
• What brings on the pain?
• When did you first discover the pain?
• Does the pain go away with rest?

Your provider will perform a physical exam of your foot, looking for structural problems and will attempt to reproduce your pain by pressing on the center of your heel. Your provider will also compare the thickness of your heel pad when you’re standing on your foot compared with when you’re not. Normal heel pad thickness is 1 to 2 centimeters (0.4 to 0.8 inches). A stiff, hard heel pad may mean your heel doesn’t have a lot of elasticity, which is a sign of heel fat pad syndrome.

Your provider may also order an X-ray, ultrasound or sometimes magnetic resonance imaging (MRI) to help make the diagnosis of heel fat pad syndrome or to rule out other causes of your heel pain.

How is heel pad syndrome treated?

Treatments include conservative approaches and more advanced techniques. The goal of conservative treatment is to reduce pain and inflammation, preserve and protect the fatty tissue that’s present and prevent further damage. Advanced treatment methods add materials to your heel to increase the thickness of your heel pad.

Conservative treatment methods include:

• Rest. Stay off your feet as much as possible and limit high-impact activities that cause heel pain.
• Apply ice. Apply an ice pack to your heel for 20 minutes intervals after activities that cause heel pain.
• Take medication. Take over-the-counter medication to help reduce inflammation and pain. Examples include ibuprofen (Advil®, Motrin®) and naproxen (Aleve®).
• Wear orthopedic footwear. See your podiatrist or visit a shoe store specializing in orthopedic footwear to be fitted with shoes that provide extra heel support.
• Taping your heel. Tape your heel in such a way as to shift and correctly reposition your heel pad under your heel bone to provide support and needed cushioning. Your provider will show you how to properly tape your foot.
• Use heel cups, shoe inserts and cushioned socks. Heel cups, shoe inserts and cushioned socks, available online or at your local drug store, provide extra heel cushioning and support.
• Exercise program. Under the guidance of your healthcare provider or physical therapist, you’ll learn proper stretches to lengthen your calf muscles and rehabilitation exercises to correct improper foot-knee-hip alignment and imbalance (if present).

Advanced treatment methods include:

• Injectables. This method uses various natural or synthetic injectable filler materials to thicken the fat pad. Dermal fillers contain such materials as poly-L-lactic acid and hyaluronic acid. Silicone is a controversial filler due to its potential to travel to other body areas, which could cause a mild-to-severe reaction. Dermal fillers can last from six to 12 months depending on your lifestyle, activities, weight and your age.
• Fat grafting or autologous fat transplantation. This method takes a tiny amount of fatty tissue from another area of your body (such as your thigh or abdomen) and places it into your heel. This is an outpatient procedure, with results lasting longer than dermal fillers.
• Allografting. This technique uses fat obtained from another person. Only fat cells are used so there’s no chance of rejection. This is a surgery and requires a longer recovery time (six to eight weeks for the new and existing tissues to heal together) than the other methods. This treatment may provide pain relief for up to five years.

Surgery may be considered to correct physical deformities in your toes, foot, ankle, leg, knee or hip that change your alignment and weight distribution and affect the quality of your life or limit your abilities.

What are the complications of untreated heel fat pad syndrome?

If you leave heel fat pad syndrome untreated, you’ll:

• Continue to have pain, which can decrease the quality of your life.
• Have difficulty walking or playing sports.
• Change the way you walk to reduce your pain, which can make you more prone to falls and injuries.

Can heel fat pad syndrome be prevented?

Although wear and tear from increasing age or a family history of this condition can’t be prevented, you can focus on certain lifestyle habits to lower your chance of developing heel fat pad syndrome. These include:

• Wear properly cushioned and sole supportive footwear at all times. Wear athletic shoes when engaging in high-impact activities. Avoid high-heeled shoes. High-heeled shoes improperly distribute weight, putting excess force on one area of your foot.
• Limit the time you spend in high-impact, weight-bearing activities (such as running, basketball, gymnastics) to allow recovery of your heel pad after these activities.
• Maintain a healthy weight.
• Avoid walking barefoot, especially on uneven and hard surfaces (such as tiles, hardwood and cement).

Inspect all your shoes. Change your shoes if you see uneven wear on the soles or inside cushioning that’s no longer supportive.

Can heel fat pad syndrome be cured?

There’s no absolute long-term cure for heel fat pad syndrome. There’s some degree of shrinkage of your heel fat pad that occurs with ordinary aging and natural wear and tear. However, by taking steps to reduce heel pain and inflammation and prevent further damage you can improve the quality of your life and continue to engage in activities that bring you joy.

What’s the difference between heel fat pad syndrome and plantar fasciitis?

Plantar fasciitis is a weakening of the connective tissue (the fascia) that supports the arch of your foot. Your plantar fascia stretches from your heel to your toes. The main symptom of plantar fasciitis is a throbbing pain in your heel. The pain is usually closer to your instep or inner part of your heel and may extend to your foot’s arch. You feel a tightness in the bottom of your foot when stretching. Also, the pain is worse in the morning with first steps after rest, improves after use but then worsens with continued weight-bearing on your foot. The pain is described as sharp and stabbing if the plantar fascia is pressed on during examination.

The pain of heel fat pad syndrome is closer to the center of your heel. Pain happens when walking or standing for long periods, when participating in high-impact activities and is aggravated with walking barefoot on hard surfaces. The pain in your heel may happen more often at night and at rest and is more likely to happen in both feet compared with plantar fasciitis.

You can have both conditions at the same time. Also, having plantar fasciitis can lead to heel fat pad syndrome. This happens because when the plantar fascia is injured, it reduces the ability to properly distribute weight on your foot when walking or running. This leads to extra pressure on your heel fat pad and quicker wearing.

What is a calcaneal stress fracture?

Your heel bone is called the calcaneus. Repetitive movements that overload weight on your heel, such as running, can cause your calcaneus to crack. This crack or break is called a stress fracture. If you have a calcaneal stress fracture, you’ll feel pain in your heel as well as at the back of your heel. The heel pain worsens over time, first starting only when engaged in activities and then later even when you are resting your foot. A bone scan, computed tomography (CT) scan or magnetic resonance imaging (MRI) scan may be needed to determine if your heel pain is due to a stress fracture.

A note from Cleveland Clinic

Heel fat pad syndrome is the loss of the thickened, cushioning pad on the heel area of the sole of your feet. This heel pad loses its density and elasticity due to wear and tear, repetitive activities that apply a lot of stress to your heel pad, heavier body weight, unequal distribution of your weight when you walk and other factors. The main symptom is deep pain in the center of your heel. Simple treatments, including rest, anti-inflammatory medication, ice and proper footwear can usually manage heel fat pad syndrome. Other advanced treatments are available and may be an option. Always see your healthcare provider if you experience heel pain. The earlier the problem can be diagnosed, the early treatment can begin, which leads to less damage and a better outcome.