Heel pad syndrome

Overview

Heel pad syndrome is a painful condition that occurs when the fat pad cushioning the heel becomes thinned, damaged, or inflamed. This fat pad normally acts as a shock absorber for the heel bone (calcaneus), protecting it during activities such as walking, running, or standing. When the heel pad loses its thickness or elasticity, the impact forces are transferred directly to the bone, resulting in discomfort or pain. Heel pad syndrome is a common cause of heel pain, particularly in older adults, athletes, or individuals who spend long hours on hard surfaces.

Causes

Heel pad syndrome results from damage or degeneration of the heel’s natural cushioning. Common causes include:

• Aging: Natural thinning of the heel fat pad over time

• Repetitive impact: Activities like running, jumping, or prolonged standing on hard surfaces

• Obesity: Excess body weight increasing pressure on the heel

• Footwear: Wearing thin-soled or unsupportive shoes

• Trauma: Direct injury or bruising to the heel

• Inflammation: Secondary to conditions like plantar fasciitis or systemic inflammatory diseases

Symptoms

The primary symptom of heel pad syndrome is deep, aching pain in the center of the heel, often described as a “bruised” sensation. Symptoms may include:

• Pain located in the middle of the heel (rather than the edge or arch)

• Increased discomfort when walking barefoot, especially on hard surfaces

• Pain worsening with prolonged standing or walking

• Less pain when using cushioned footwear or when offloading weight

• Possible tenderness on palpation of the heel pad

Diagnosis

Diagnosis is typically made based on clinical history and physical examination. Key steps include:

• Patient history: Assessing the nature, location, and aggravating factors of heel pain

• Physical exam: Pressing on the center of the heel reproduces pain

• Imaging: Ultrasound or MRI may show thinning or degeneration of the heel fat pad and rule out other conditions like plantar fasciitis or calcaneal stress fracture

It is important to differentiate heel pad syndrome from other causes of heel pain, such as plantar fasciitis, which typically causes pain closer to the front of the heel or medial arch.

Treatment

Treatment for heel pad syndrome focuses on reducing impact stress and alleviating pain. Common approaches include:

• Footwear modifications: Using well-cushioned shoes or shock-absorbing insoles

• Heel cups or gel inserts: To protect and support the heel pad

• Activity modification: Reducing time spent on hard surfaces and avoiding high-impact activities

• Weight management: To decrease pressure on the heel

• Ice therapy: To reduce inflammation after activity

• Physical therapy: Stretching and strengthening exercises for foot and calf muscles

• Pain relief: NSAIDs or topical analgesics may be used if pain persists

In rare and severe cases, medical interventions like corticosteroid injections or surgical fat pad augmentation may be considered.

Prognosis

With conservative treatment, the prognosis for heel pad syndrome is generally good. Most patients experience significant improvement by modifying footwear, activity, and lifestyle habits. Chronic or untreated cases may result in prolonged discomfort or altered gait mechanics, which can lead to secondary issues. Early recognition and intervention are key to preventing long-term complications and returning to pain-free mobility.