Fat Pad Syndrome of the Foot

What is fat pad syndrome?

Heel pain is a common complaint and often there is a premature jump to conclude that the cause is plantar fasciitis.

Whilst, plantar fasciitis is one of the most probable causes of heel pain. There are those occasions where the heel pain may not be due to an injury sustained to the fat pad of the heel itself.

The fat pad acts as a cushioning layer between the calcaneus (heel bone) and the ground.

Its primary purpose is to divert forces away from the calcaneus and protect it from injury/irritation by way of shock absorption.

In fat pad syndrome there is an abnormal breakdown/thinning of the fat pad, leading to significant inflammation of the fat pad.

How does fat pad syndrome develop?

There are two typical mechanisms that can cause fat pad syndrome to develop.

Firstly, through repetitive trauma/over use the fat pad can become inflamed. Activities, such as, gymnastics (running and jumping) involved repetitive, forceful load to be applied to the fat pad which leads to irritation. This irritation leads to inflammation which is consistently aggravated through ongoing activity.

Another way in which fat pad syndrome can develop is through the degeneration as we age. As we age, many of our body systems go through a degenerative process in which they become less effective. This is no different when talking about soft-tissue (including the fat pad).

Through degenerative processes there is a thinning of the fat pad, which decreases its ability to provide appropriate shock absorption. This leads to an increase susceptibility to acquire bruising to the fat pad or calcaneus bone, causing significant discomfort.

Being overweight, age, the individual mechanics of the foot, having a job that requires long hours of standing, or participating in high impact sport can all exacerbate the condition and cause wear and bruising to the fat pad and the calcaneus bone.

What are the symptoms?

Fat pad syndrome presents with pain in the centre of the heel. It is often described as feeling like walking on a bruise. The pain is exacerbated when standing for extended periods of time or during high impact activities, as well as, when walking on firm surfaces without footwear.

What to do for fat pad syndrome?

A visit to see a physiotherapist or podiatrist will help to gain an accurate diagnosis and lead you down an appropriate rehabilitation path.

Once an accurate diagnosis has been found there are many ways to treat this condition. Firstly, it is important to reduce the load through the injured area and allow time for healing. This can be achieved through;

• De-load taping/heel cups to increase cushioning.
• Anti-inflammatory medication.
• Activity modification.
• Relative rest.
• Soft tissue massage.

After the initial period of pain has settled it is now vital to address any potential contributing factors that predispose to developing fat pad syndrome.

• Weight loss exercise program.
• Appropriate foot wear prescription.
• Orthotic prescription.

Our highly qualified at Pivotal Motion Physiotherapy can help to differentiate fat pad syndrome from plantar fasciitis or a more serious condition of calcaneal fracture. If you believe you have fat pad syndrome, book an appointment online or call our friendly staff on 07 3352 5116.