Heel pad syndrome

Heel pad syndrome is a pain that occurs in the center of the heel.[1] It is typically due to atrophy of the fat pad which makes up the heel. Risk factors include obesity.[1] Other conditions with similar symptoms include plantar fasciitis.[1] Treatment includes rest, pain medication, and heel cups.[1] It becomes more common with age.[1]

Heel pad syndrome
Other namesHeel fat pad syndrome, heel pad atrophy, heel fat pad atrophy
SpecialtyPodiatry

Signs and symptoms
  • Pain in the heel, usually on the middle of the heel. This is in direct contrast to plantar fascia pain or heel spur pain which is present at the front of the heel, not the middle.
  • Pain is usually a deep, dull ache that feels like a bruise.
  • Pressing with the thumb into the centre of the heel should re-create the pain.
  • Condition can often be attributed to a blow to the heel – landing hard while barefoot on a hard surface, jumping in dress shoes with a hard heel, stepping on a stone while running.
  • Pain is aggravated by walking barefoot on hard surfaces like ceramic tile, concrete, hardwood floors, etc.

Diagnosis

The main differential diagnosis of heel pad syndrome is plantar fasciitis. In heel pad syndrome all parts of the heel are tender while in plantar fasciitis typically only the part of the heel closer to the toes is sore.[2]

Treatment

Manual therapy and exercise have better efficacy in the long term than electrophysical agents and exercise for function, but not for pain.[3] Manual therapy and exercise are preferably focused at stretching the plantar fascia.[4]

Foot orthoses however do not appear to help with heel pain.[5]

References
  1. Tu, P; Bytomski, JR (15 October 2011). "Diagnosis of heel pain". American Family Physician. 84 (8): 909–16. PMID 22010770.
  2. Anderson, Bruce Carl (2006). Office orthopedics for primary care : diagnosis. Philadelphia: Saunders Elsevier. p. 239. ISBN 9781416022077.
  3. Rasoulian, McElfresh, Elliott, Rodriguez. "Heel Fat Pad Syndrome - A Clinical Management Guideline" (PDF). PT Coop.org. Archived from the original (PDF) on 2015-06-16. Retrieved 2016-06-03.{{cite web}}: CS1 maint: multiple names: authors list (link) August 2012
  4. Vinod K Panchbhavi (2016-04-18). "Plantar Heel Pain Treatment & Management". Medscape.
  5. Rasenberg, N; Riel, H; Rathleff, MS; Bierma-Zeinstra, SMA; van Middelkoop, M (19 March 2018). "Efficacy of foot orthoses for the treatment of plantar heel pain: a systematic review and meta-analysis". British Journal of Sports Medicine. 52 (16): 1040–1046. doi:10.1136/bjsports-2017-097892. PMID 29555795.
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