Maybe it’s not Plantarfasciitis but Heel Fat Pad Syndrome

Do you have heel pain? And think it is Plantar Fasciitis?

Maybe not, it might be another type of heel pain called the Heel Fat Pad Syndrome.

What´s the difference between the Plantar Fasciitis and Heel Fat Pad Syndrome?

Source: AAF
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As shown in the illustration, both structures are in the same area of the heel whereas the plantar fascia (illustrated as plantar apponeurosis) is covered by the fat pad. The plantar fascia attaches at the toes and forms the medial (longitudinal) arch of the foot. It provides static support of the medial arch and dynamic shock absorption. The main functions of the fad pad is shock absorption of stress during heel strike (heel contact during walking).

While both the heel fat pad and plantar fascia can be a source for heel pain, the contributing factors, clinical signs and symptoms and management for them differ.

Plantar Fasciitis

Plantar fasciitis is an overuse condition of the plantar fascia.

Contributing factors: It is often seen in people with foot deformities e.g. flat feet (low arches) or pes cavus (high arches). This deformities can lead to an excessive strain at the fascia during walking and hence cause pain. Other risk factors which can lead to increased stress in the fascia are inappropriate or non-supportive footwear, reduced ankle mobility, obesity and work related weight bearing.

Clinical signs and symptoms: A typical clinical sign is swelling of the plantar fascia and can be confirmed by ultrasound investigations. People with plantar fasciitis classically have a gradual onset of symptoms and feel their pain more on the inner side of the heel. Further symptoms are acute tenderness of the inner side of the heel, a tight plantar fascia and pain during stretching of the fascia. Especially the first steps in the morning or after rest are painful. The pain seems to decrease after a few minutes, and returns as the day proceeds and time on the feet increases.

Management: Due to the tightness of the plantar fascia that leads to pain, treatments involve stretching and massaging to release the tight fascia and calf muscles. Other management include avoiding aggravating activities (e.g. wearing heels), cold therapy (R.I.C.E), anti-inflammatory drugs, taping to to relief pain and lastly it is crucial to strengthen calf muscles that have weakened during the pain process. Some patients who are still symptomatic after conservative treatment might need surgery.

Heel Fat Pad Syndrome

Heel fat pad syndrome is often caused by a decreased elasticity of the fat pad. A fall onto the heel from a height or chronically excessive heel strike with poor footwear can also lead to heel pain.

Contributing factors: Increased age and weight decreases the elasticity of the fat pad.

Clinical signs and symptoms: Compared to plantar fascitis, fat pad related heel pain is felt more at the outer side of the heel especially when the heel gets loaded (heel strike). MRI investigations will reveal changes in the fat pad showing signs of swelling.

Management: Treatments aimed at unloading the heel by avoiding aggravating activities. In an acute situation the R.I.C.E. rule (Rest Ice Compression Elevation) should be applied and anti inflammatory drugs are given. Further treatment includes taping, the use of a silicone gel heel pad and use of appropriate footwear.

References:

  1. Brukner, P & Khan, K 2007, Clinical Sports Medicine, 3rd edition, Tata McGraw Hill, Australia .
  2. Cole, C, Seto, G & Gazewood, J 2005, 'Plantar Fasciitis: Evidence-Based Review of Diagnosis and Therapy`, American Family Physician, vol. 72, no. 11, pp. 2237-42.
  3. Thomas, JL, Christensen,, JC, Kravitz,, SR, Mendicino, RW,  Schuberth, JM, Vanore, JV, Weil, LS, Zlotoff, HJ, Bouche, R & Baker, J 2010, ´ The Diagnosis and Treatment of Heel Pain: A Clinical Practice Guideline–Revision 2010`,The Journal of Foot & Ankle Surgery, vol. 49, pp. 1-19.
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Comments

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  • Sparkavenew

    Hello!! I appreciate the FAT PAD syndrome topic and acknowledement that FAT PADS decline does INFLICT unhappiness in feet!! Thank You!! However, it is ALWAYS stated that “APPROPIATE” shoes CAN make some difference, maybe even FIX the problem in the FIRST place…or wait, use this hard plastic heel pad or silicone/gel…These items create other problems and where’s the education in that? WHERE ARE THESE “APPROPIATE” SHOES??? Cuz all I’m finding are EMPTY CALORIE EYE-CANDY “BARBIE” CRAP FOR MALE & FEMALE!!nsparkavenew@gmail.com

  • http://pulse.yahoo.com/_VR4NSXX6GSP47QZ6GZLLSZTUBQ Dave Sparks

    Hello,
    This is a very nice post as it has some very useful,helpful, rare and precise information which is quite hard to find. Also I appreciate your writing skills as well.
    Well done. :)
    _____________
    symptom diagnosis

  • http://shanx.com Shanx

    Glad they work for you. A dear friend of mine got these. Apart from looking ugly, they made her fall flat on her face in the middle of traffic. Sorry, but not a cool suggestion. A proper Asics or similar shoe with the right padding and arch support (get recommendations for the right model for your feet) is much better than all these gimmicky shoes.

  • Maryssm

    Though I’m still trying to determine exactly what I have, this is the closest.  It doesn’t make sense to use gel inserts or a “molded” custom device (Dr recommended)  both didn’t work.   The smooshiness of the gel made heel pain worse. The custom orthotic does nothing but mimic the heels shape. I’m starting to think the way to deal with this problem is to proactively wrap heels in a way to collect fat around heal.  This is narrowing the surface area and creating a cushion (from what little fat there is).  Has anyone tried wrapping their heels with athletic tape?  Will give it a go this week hiking to see if this helps.  my pain is localized around the heel does not radiate completely to the outside edge.

  • SARA

    I have had this soo called Fat Pad Syndrome for 6 months now…so far have tried the heel pad and wrapping it everyday…the problem still exists…next step will try new footwear………Starting to feel that this will never go away…

  • Mneott

    I wrap my heels whenever needed and along with the proper orthotic shoes (custom insoles in New Balance walking runners purchased at Canadian Footwear for $130), I feel somewhat normal for a short period of time. The tape can be irritating, but helps somewhat. I’m 35 and female. 135 pounds. As bad as it sounds, it is great and reassuring to hear that others have this problem too!

  • http://www.facebook.com/Slyone Sandra Wosk-Smale

    I have had this problem for almost ten years now.. two sets of very expensive orthotics, ton of gel inserts and ice wrapping.. and guess what.. NOTHING WORKS AT ALL. I will have this forever and it never goes away.. at least with Plantar F you can get surgery and be done with it but with this Fat Pad stuff it is with you for the rest of your life. I am 58 years old and I can barely walk . I have tried footwear from everywhere and believe me when I say nothing works. IF you have found something that works for you great but for most of us it never does.

  • DR

    With a screwed up face, the clerk at REI looked at the squishy gel pad the doctor gave me. He said “You don’t need less support, you need MORE support. These things will just squish out and cause fatigue.” He recommended Super Feet insoles. These have caused a HUGE improvement in my everyday footwear. Additionally, I have a pair of Dansko closed-back clogs that I at leave at work. I can be on my feet all day with almost no discomfort. These clogs are very stiff. This is counter-intuitive, but the REI sales clerk pointed out that this is because they are supporting the feet, not just squishing out.

  • Maria

    I’ve thought the sane thing! I’ve had this issue since I was 8 years old, I’m now 40! Nothing the doctors do ever works. My heels feel bruised constantly. And I get sharp pains in my arches that sometimes send me to my knees. I have even thought of having fat sucked out of my gut and putting in my heel pad!