Fat Pad Syndrome

What is Fat Pad Syndrome?

Fat pad syndrome usually affects the centre of your heel and happens because the fat pad gets thinner and wears out. It can feel a lot like plantar fasciopathy.

However, with fat pad syndrome, the pain is not as bad when you first get up in the morning or after resting. The pain gets worse the more you walk or stand.

The plantar fat pad is the soft tissue between your skin and heel bone. It has a honeycomb-like structure with small chambers of fat that help absorb shock and spread pressure when you move.

When the fat pad cannot absorb shock well, your heel bone can get hurt from repeated stress. This can cause long-term inflammation, bruising, swelling, and pain in the heel bone.

More pressure on the heel can also irritate or inflame the bursa, a small fluid-filled sac under the fat pad. The bursa helps absorb shock and reduce friction.

What are the symptoms of Fat Pad Syndrome?

• A gradual onset of a dull achy pain under the centre of the heel.
• Pain increases with activity during periods of standing or walking.
• Localised swelling that can cause discomfort when wearing footwear.
• The heel can feel tender or warm and is more painful when you press directly on it.

What causes Fat Pad Syndrome? 

In most cases, fat pad syndrome develops because of repeated overuse.

You may have contributing factors related to fat pad syndrome:

• Being overweight
• Age (from 30+ years) natural thinning of the fat pad
• Wearing inappropriate unsupportive footwear
• Spending long periods standing or walking, especially with a sudden increase in these activities
• Diabetes
• Inflammatory conditions i.e. rheumatoid arthritis, psoriatic arthritis etc.
• Weakness in the muscles within your feet or leg
• Tightness of the muscles in the backs of your legs
• Not allowing adequate recovery time between activities
• Prolonged use of oral corticosteroids

What can help with Fat Pad Syndrome?

Unfortunately, there is no quick or easy fix, and your symptoms will not improve overnight. The advice below is focused on reducing your symptoms to help you get back to normal activity. Most peoples’ symptoms improve but it may take several months to get better.

Making changes to your lifestyle as well as reducing aggravating activities is key to helping your recovery. Only you can do this.

There are a few things you can try including:

• Rest and raise your foot on a stool when you can
• Put an ice pack (or bag of frozen peas) in a towel on the painful area for up to 20 minutes every 2 to 3 hours
• Wear shoes with cushioned heels and good arch support
• Use insoles or heel pads in your footwear
• Try regular stretching and foot exercises
• Try exercises which put no pressure on your feet, such as swimming
• Try to lose weight if you are overweight or obese

These a few things to try to avoid including:

• Avoid walking or standing for long periods
• Avoid wearing high heels and tight pointy shoes
• Avoid wearing flip-flops or backless slippers
• Avoid walking barefoot on hard surfaces