Heel Fat Pad Syndrome

This article is currently under review and may not be up to date. Please come back soon to see the finished work! (15/03/2021)

Original Editor - Puja Gaikwad

Top Contributors - Puja Gaikwad and Kim Jackson  

Introduction

Heel Fat Pad Syndrome (HFPS) is a condition that happens as a result of changes in the elasticity and/or the thickness of the heel fat pad. This is often caused by wear and tear over time of the fatty tissues and muscle fibers that make up the heel pads leading to heel pain that could impact our daily routine and interfere with our regular activities. Too much wear and tear can cause heel pads to shrink in size or lose their elasticity. When fat pad atrophy occurs, destruction of the fibrous membrane in the heel pad begins to occur, in addition to the loss of moister and soft tissue elasticity reduction leading to impaired shock absorption mechanism. It is also termed Fat Pad Atrophy (FPA). It is considered to be the second leading cause (14.8%) of plantar heel pain after plantar fasciitis. It is commonly misdiagnosed as Plantar fasciitis, while both can be a source of heel pain but the risk factors, symptoms, and treatment vary for each condition.

Anatomy

The heel fat pad is a specialized adipose structure overlying the calcaneum and proximal plantar fascia which are enclosed by ligamentous chambers that serve to cushion the impact of heel strike during locomotion. It also serves as a mechanical anchor that helps to disperse body weight appropriately without putting excessive pressure on the underlying tissues. The heel can absorb 110% of the body’s weight during walking and 200% of the body’s weight during running; this excess mileage and chronic increase in pressure strike and load forces could lead to thinning of the heel fat pad, experiencing a common complaint of heel pain. A fat pad, known as the ‘corpus adiposum’ is usually about 1-2 cm in thickness with the average healthy calcaneal fat pad measuring approximately 18 mm thick.

Symptoms

Symptoms of fat pad syndrome may include:

• Patients with heel pad syndrome present with deep, bruise-like pain, usually in the middle of the heel while walking, running, or standing for a long time.
• It can be reproduced with firm palpation.
• This pain increases in severity by prolonged walking or standing, especially when barefoot, walking on hard surfaces, or while performing any high-impact activities.
• Mild cases of heel pad syndrome might be asymptomatic or felt occasionally when aggravated by pressing on it directly or came in contact with hard surfaces such as hardwood floors, concrete or ceramic tiles.
• Pain is typically experienced on one side (i.e. within one heel, not both).

Although similar in presentation, the pain from HFPS is felt in the middle of the heel, rather than at the front of the heel bone during Plantar Fasciitis.