What to Know About Heel Fat Pad Syndrome

Medically Reviewed by Poonam Sachdev on October 18, 2022
5 min read

The thick pads on your heels are essential to your overall comfort as you stand, walk, run, and complete other daily activities. These pads of tissue can sometimes thin out over time, leaving you uncomfortable and causing pain. This condition is called heel fat pad syndrome, and it’s more common than you might think. 

Heel fat pad syndrome is a condition where the fat pad on your heel thins, causing pain during everyday activities like walking or standing. It’s also commonly known as plantar fat pad syndrome or heel fat pad atrophy.

The heel pad on the soles of your feet are made of a thick layer of tissue. It’s normal for them to wear down a bit over time as you age, but too much wear and tear on your heels can cause pain and mobility issues. 

Heel fat pad syndrome is one of the most common causes of heel pain in adults and is a result of gradual wear and tear on your heel pad over time. Other factors that cause extra pressure on your heel fat pad can also contribute to quicker wearing of the tissue in your heels.

Your doctor can diagnose heel fat pad syndrome by asking you specific questions about your symptoms and medical history, such as:

  • What does the pain feel like and where do you feel it?
  • Does the pain increase when you put weight on it?
  • When did you first start experiencing the pain?
  • How long have you had the pain?

They may also examine your foot to see if they can easily feel your bone through your heel pad or if the skin over your heel is very wrinkly and deflated when squeezed. Your doctor might also press firmly on the center of your heel to trigger and then assess the severity of the pain you’re feeling.

During the exam, your doctor may also measure the thickness of your heel pad to determine whether you have fat pad syndrome. The heel pad of a person without fat pad syndrome is about 1 to 2 centimeters thick. A fat pad that measures less than 1 centimeter in thickness is significantly worn down.

Since there are several other potential causes of heel pain, your doctor may also use an x-ray, ultrasound, or magnetic resonance imaging (MRI) to help diagnose heel fat pad syndrome.

Most often, heel fat pad syndrome symptoms include:

  • A deep pain that feels like a bruise in the middle of your heel
  • Foot pain when walking, running, or standing
  • Pain when walking barefoot or on a hard surface like concrete or wood flooring
  • Pain when pressing your fingers into the middle of your heel

Some of these symptoms may not be as noticeable as others, especially if you have a mild case of heel pad syndrome. The best way to determine whether or not you have this condition is to see a doctor.

Several contributing factors can cause heel fat pad syndrome, such as:

  • Obesity: If you have excess body weight, you’re more likely to develop heel fat pad syndrome because the additional pounds put more pressure on your feet when you walk, run, and stand.
  • Repetitive, high-impact activities: The fat pads on your heels are more likely to become inflamed due to repetitive or prolonged activities that continually put pressure on your feet, such as sports like basketball or gymnastics. Even just walking or running on hard surfaces like concrete or tile frequently can cause additional fat pad atrophy.
  • Age: As you age, the fatty tissue in your heels naturally gets thinner and loses elasticity, increasing your risk of developing heel fat pad syndrome.
  • Gait imbalances: If you walk with your feet pointing inwards or outwards, your heel pads may wear down more quickly over time.

Although it’s much less common, certain medical conditions can also contribute to heel fat pad syndrome, including: 

  • Type 2 diabetes, which is when your body doesn’t use insulin properly. This disease can break down fat and collagen in your heel fat pad.
  • Rheumatoid arthritis, a type of arthritis where your immune system attacks tissues in your body, including the connective tissue in your feet.
  • Lupus, a chronic disease that can cause inflammation and pain in the body. It can also affect the connective tissue in your feet.
  • Plantar fasciitis, which is inflammation of the ligament that connects your toes to your heel. 
  • High foot arches, a condition that can permanently damage your foot structure and lead to heel fat pad syndrome.

Many forms of treatment can reduce the pain caused by heel fat pad syndrome and improve the overall quality of your life. Some examples include:

  • Resting and limiting high-impact activities that cause heel pain
  • Taking over-the-counter medications to reduce pain and inflammation
  • Applying ice to the affected heel(s) after activities that cause pain
  • Taping your foot to reposition your heel pad
  • Wearing shoes that provide extra heel support
  • Getting natural or synthetic injectable fillers to thicken your heel fat pad
  • Having a surgical procedure that removes fatty tissue from another part of your body and replaces some of the worn-down tissue in your heel fat pad

The best type of treatment will vary from person to person and largely depends on the severity of the heel fat pad syndrome. Other influential factors include your medical history, personal preferences, and doctor’s recommendations.

Not treating heel fat pad syndrome can drastically reduce your quality of life because walking or doing other activities can be difficult and painful. The heel pain might also affect your walking gait, potentially leading to future falls and injuries.

Some causes of heel fat pad syndrome, like age or genetics, can’t be avoided. However, you can reduce your risk of getting heel fat pad syndrome with the following behaviors:

  • Wear highly supportive and cushioned footwear, especially for high-impact physical activities like sports.
  • Reduce the time you run, walk, or stand to limit the stress on your heel fat pads.
  • Don’t walk barefoot on hard surfaces.
  • Maintain a healthy weight with proper diet and exercise.
  • Try not to wear high heels often. They can place more pressure on specific areas of your feet, which may increase your discomfort.