Heel Fat Pad Syndrome

Heel Fat Pad Syndrome is a condition that results from changes in elasticity and/or thickness of the heel fat pad. The heel fat pad is a structure overlying a bone in the heel of your foot and serves to cushion the heel during weight bearing activities. Heel Fat Pad Syndrome is the second leading cause of heel pain, with plantar fasciitis being the number one.

Patients typically have the following signs and symptoms:

• Deep, bruise-like pain in the middle of the heel that is worse with long periods of weight bearing activities
• Reproduction of pain while firmly pushing the heel under surface
  • Worse pain when weight bearing on hard surfaces such as hardwood floors, concrete or ceramic tiles
• Limited ankle mobility

As with plantar fasciitis, X-ray and MRIs are not necessary to diagnosis Heel Fat Pad Syndrome.

Treatment includes:

• Manual therapy including joint and soft tissue mobilizations to improve ankle/foot mobility/flexibility
• Stretching to increase ankle and foot flexibility
• Taping to increase padding over the heel
• Exercises to strengthen foot muscles Exercises to improve movement quality to better control foot movement and to better attenuate forces during weightbearing activities such as walking.

References:

1. Martin, Robroy, et al, “Heel Pain—Plantar Fasciitis: Revision 2014 Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health,” from the Orthopaedic Section of the American Physical Therapy Association.” Journal of Orthopaedic & Sports Physical Therapy, Vol. 44, No. 11.
2. Hossain, Munier, and Nilesh Makwana, “‘Not Plantar Fasciitis’: The Differential Diagnosis and Management of Heel Pain Syndrome.” Orthopaedics and Trauma, Vol. 25, No. 3, 2011, pp. 198–206, https://doi.org/10.1016/j.mporth.2011.02.003.

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