Fat Pad Syndrome: Causes, Symptoms, and Treatment Options

Fat pad syndrome

Dear Doctor, could you please explain what fat pad syndrome is and whether it can occur in the soles of the feet? Are there any websites or resources with more in-depth information about this condition? Thank you.

K.D., 40~49 year old female. Ask Date: 2006/04/18

Dr. Chen Shunsheng reply Rare Disease

Fat Pad Syndrome
This is a condition that is not commonly seen; it is not specific to runners, triathletes, or training in general.
However, because it is often misdiagnosed by doctors, I thought it deserved its own page.
Essentially, it is a sore heel—the pain is concentrated in the center of the heel and feels like a deep bruise.
Many doctors who do not frequently encounter athletic injuries may have never heard of Fat Pad Syndrome and, when faced with heel pain, may default to diagnosing 'plantar fasciitis.' I have even seen patients whose doctors never examined or touched their foot; they simply prescribed orthotics and claimed the patient had 'heel spurs.'
The Anatomy
Humans are designed to function barefoot.
While running shoes provide significant cushioning and stability, we could essentially run barefoot if we chose to (as evidenced by young Kenyans running in their native country or by Zola Budd, who raced barefoot on the track).
The natural design of the foot is remarkable because not only do the bony arch and the plantar fascia function as shock absorbers, but there is also about a 1-inch thick pad of fatty tissue between the skin and the heel bone (the 'calcaneus') that acts as a cushion.
This cushion is referred to as a 'fat pad' due to its composition of primarily fatty tissue.
The fat pad is somewhat divided into sections by ligamentous 'baffles' that help prevent the fat pad from spreading out, thereby maintaining the cushion's position under the heel.
Occasionally, the heel can sustain an injury, causing these baffles to stretch, which allows the fat pad to spread out and diminishes the cushioning effect—making weight-bearing very uncomfortable.
Fortunately, it is treatable.
Signs and Symptoms
- Pain in the heel, typically located in the middle of the heel.
This is in direct contrast to plantar fascia pain or heel spur pain, which is felt at the front of the heel, not the middle.
- The pain is usually a deep, dull ache that resembles a bruise.
- Pressing your thumb into the center of the heel should reproduce the pain.
- The condition can often be linked to a blow to the heel—such as landing hard while barefoot on a hard surface, jumping in dress shoes with a hard heel, or stepping on a stone while running.
- Pain is exacerbated by walking barefoot on hard surfaces like ceramic tile, concrete, hardwood floors, etc.
What To Do About It
Once you can rule out plantar fasciitis as the cause of the problem, you can confirm a diagnosis of 'Fat Pad Syndrome' by taping the heel to hold the fat pad underneath it.
After taping your heel—or having someone do it for you—walk barefoot on a hard surface and see how it feels.
If the pain decreases or disappears, you have confirmed your suspicion—it is likely Fat Pad Syndrome.
So, what should you do now? Fat Pad Syndrome will heal over time; you just need to minimize the pain while it heals, thereby reducing the inflammatory process and promoting recovery.
You could continue to tape the heel with athletic tape; however, this can be time-consuming and may irritate the skin after several applications.
Alternatively, check your local running specialty store for a 'heel cup,' which is a small plastic cup that surrounds the heel and compresses the fat pad under the calcaneus.
It should fit snugly around the heel so that when you place your foot in your shoe, it compresses the sides of the heel.
If a heel cup does not work, a heel pad can be added to the shoe for extra cushioning.
These are typically small foam or gel pads that soften the impact on the heel but do not hold the fat pad in place.
Additionally, make sure to ice your heel after exercise, wear well-cushioned shoes whenever possible, and limit exposure to hard surfaces while barefoot.
Orthotics may also be beneficial, provided they are designed with a proper heel cup.
Anti-inflammatory medications can be helpful as well, but the other suggestions mentioned are generally more effective.

Reply Date: 2006/04/18

More Info

Fat Pad Syndrome, often referred to as heel fat pad syndrome, is a condition that primarily affects the heel of the foot. It occurs when the fat pad, which serves as a cushion between the heel bone (calcaneus) and the ground, becomes damaged or atrophied. This syndrome is not as commonly recognized as other foot conditions, such as plantar fasciitis, which can lead to misdiagnosis.

Causes of Fat Pad Syndrome
The fat pad in the heel is composed of fatty tissue that provides cushioning and absorbs shock during activities such as walking or running. Several factors can contribute to the development of Fat Pad Syndrome:
1. Trauma or Injury: A direct blow to the heel, such as landing hard on a hard surface while barefoot or jumping in shoes with a hard heel, can damage the fat pad.

2. Overuse: Repetitive stress from activities like running or jumping can lead to inflammation and irritation of the fat pad.

3. Age: As individuals age, the fat pad can naturally thin, leading to decreased cushioning and increased susceptibility to pain.

4. Foot Structure: Certain foot types, such as flat feet or high arches, can place additional stress on the fat pad, increasing the risk of injury.

Symptoms
The primary symptom of Fat Pad Syndrome is pain in the center of the heel, which is often described as a deep, dull ache that feels like a bruise. This pain can be exacerbated by walking barefoot on hard surfaces, such as tile or concrete. Unlike plantar fasciitis, where pain is typically felt at the front of the heel, Fat Pad Syndrome pain is concentrated in the middle.
Other symptoms may include:
- Tenderness when pressing on the center of the heel.

- Pain that worsens with activity and improves with rest.

- Swelling or inflammation in the heel area.

Diagnosis
Diagnosing Fat Pad Syndrome can be challenging, as many healthcare providers may not be familiar with it. A thorough clinical examination is essential, and the doctor may perform specific tests, such as pressing on the heel to reproduce the pain. It is crucial to differentiate it from other conditions like plantar fasciitis or heel spurs, which may require different treatment approaches.

Treatment Options
Fortunately, Fat Pad Syndrome is treatable, and several options are available:
1. Rest and Activity Modification: Reducing activities that exacerbate the pain is crucial. Avoiding hard surfaces and high-impact activities can help alleviate symptoms.

2. Ice Therapy: Applying ice to the heel can help reduce inflammation and numb the pain.

3. Footwear Changes: Wearing well-cushioned shoes that provide adequate support can significantly reduce heel pain. Avoiding high heels or shoes with hard soles is recommended.

4. Orthotics: Custom orthotic devices or heel cups can provide additional cushioning and support to the fat pad, helping to alleviate pain.

5. Physical Therapy: Engaging in physical therapy can help strengthen the muscles around the foot and improve flexibility, which may relieve pressure on the fat pad.

6. Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can be used to manage pain and inflammation.

7. Taping: Taping the heel can help hold the fat pad in place and provide temporary relief.

8. Surgery: In rare cases where conservative treatments fail, surgical intervention may be considered to repair or reposition the fat pad.

Additional Resources
For more in-depth information about Fat Pad Syndrome, you can refer to specialized medical websites or consult with a podiatrist or orthopedic specialist. Websites such as the American Academy of Orthopaedic Surgeons (AAOS) or the American Podiatric Medical Association (APMA) may provide valuable insights and resources.

In conclusion, Fat Pad Syndrome is a manageable condition that can significantly impact quality of life if left untreated. Understanding its causes, recognizing the symptoms, and seeking appropriate treatment can lead to effective relief and recovery. If you suspect you have this condition, consulting a healthcare professional specializing in foot and ankle disorders is advisable for an accurate diagnosis and tailored treatment plan.

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