Fat Pad Syndrome
What Is It?
Fat pad syndrome (plantar fat pad syndrome) is a common condition that affects the heel pad. This fatty heel pad is roughly 18mm thick and is held in place by connective tissues.
It serves as a shock absorber for the heel, helps to transfer weight smoothly during activity, and protects the bones from the repetitive impacts that occur in everyday activities such as walking and running.
Leonardo DaVinci once described the human foot as a “marvel of engineering”. With 26 bones, 33 joints, 107 ligaments and around 19 muscles and tendons in the human foot, it’s hardly surprising that sometimes things can go wrong. The plantar fat pad is no exception.
Plantar Fat Pad Syndrome
Trauma, excessive stress and repeated overuse can inflame, thin or even displace this protective pad creating a painful and debilitating condition.
Fat pad syndrome also goes by the names of “Bruised heel” and “Policeman’s heel” or “Fatpad atrophy”.
It’s probably the second most common cause of heel pain after plantar fasciitis.
Causes
A number of events may cause Fat pad syndrome. In simple terms, these include:
- Overuse or strain
- Injury or trauma
- Gait issues (heel strike)
- Faulty biomechanics
- Incorrect footwear
- Direct trauma to heel
- Atrophy due to ageing
Fat pad syndrome may be simply a matter of inflammation due to overuse or repetitive activities. Typical examples might be sports that involve a lot of jumping such as basketball, gymnastics or running.
Walking or running on particularly hard surfaces such as concrete can also trigger bruising, inflammation or undue wear and tear of the fat pad.
Some people use more force in their stride than is necessary (notably those who strike the ground forcefully with their heels) and this too will increase the likelihood of developing Fat Pad Syndrome. People who are overweight or obese are also more likely to develop some Fat Pad pain.
People with gait issues are at risk of developing fat pad syndrome because the inefficient action of the legs and feet places excessive pressure on the heel pad.
The elderly are prone to develop fat pad syndrome due to the thinning of the pad and the atrophy of the tissues holding the pad in place. There are some medical conditions that may also make Fat Pad Syndrome more likely to occur. These include diabetes and rheumatoid arthritis.
Symptoms
Typical Fat Pad Syndrome symptoms include:
- Constant, stone bruise-like heel pain
- Heel is painful when squeezed
- Pain increases with severity of activity
- Pain will often be present at rest and at night
- Swelling and bruising may be present in the heel
Usually, you will feel the pain in the centre of the heel pad.
This distinguishes Heel Fat Pad syndrome from plantar fasciitis where pain is typically felt on the front outer edge of the heel.
Treatments
RICE (rest, ice, compression, elevation) is always a good first aid approach to bruising and overuse injuries. This issue can take a long time to resolve and it’s important to analyse the severity, investigate the cause and find really effective solutions. If you ignore the warning signs and continue to overuse or inflame the heel pad you can do permanent damage.
Your podiatrist will probably recommend a reduction in training or exercise severity during the healing process to allow the fat pad inflammation to settle down. You’ll want to avoid walking barefoot on hard surfaces for some time too.
Further Treatments
Strapping is very effective for stabilising the heel pad and relieving some of the discomfort. Heel pads for your footwear will provide additional support and help reduce the pressure on the area.
Your podiatrist may need to undertake an indepth analysis to identify any gait or biomechanical issues that might be causing undue pressure on the heel pad. The podiatrist will also want to rule out disease conditions such as diabetes.
Analysis may indicate that custom orthotics and gait retraining will be useful to prevent any return of the problem.
Nonsteroidal anti-inflammatories such as Ibuprofen may also help ease the inflamed fat pad.
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