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Fat Pad Syndrome

Heel Pain isn’t Always Plantar Fasciitis!

Podiatrists often hear complaints for heal pain. Plantar fasciitis is more often than not the diagnosis.

However, there are those occasions where the heel pain may not be due to plantar fasciitis, but rather a contusion or injury sustained to the cushioning fat pad of the heel itself.

What is the Heel Fat Pad?

The heel bone; referred to as the calcaneus; is responsible for initial ground contact in human locomotion. As a result, large amounts of pressure and force travel through the calcaneus when we walk, run or jump. This force exposure means that the calcaneus is prone to injury through these movements and with increases in loading, age or exposure to trauma.

Beneath the heel bone lies a fat pad. Known as the corpus adiposum, this provides cushioning and shock absorption between the calcaneus and the ground. When the fat pad is healthy it is robust enough to withstand high impact forces, such as those experienced through running which equate to five times the body weight.

What are Symptoms of Fat Pad Syndrome?

The symptoms of Fat Pad Syndrome are generally clear and indicative of the underlying condition. Common signs and symptoms include:

  • Pain in the centre of the heel – will usually present as a dull, deep ache and feel like a bruise when weight-bearing.
  • Pain aggravated by walking in barefoot or on harder surfaces.
  • Felt more on the outer (lateral) side of the heel.
  • MRI investigation will reveal signs of swelling and structural change to the fat pad.

What is Fat Pad Syndrome?

Through various mechanisms, the fat pads in our feet are susceptible to degeneration and injury. These issues can range in severity from a mild nuisance to debilitating. The two most common mechanisms of Fat Pad Syndrome are:

  1. Ageing:

As we age, the fat pad is prone to degeneration, or thinning out. As a result, it provides less cushioning and subsequently the forces usually dissipated by the fat pad are applied directly to the bones. This decreased shock absorption capacity can mean that there is significant pain while walking, especially in heel strike.

  1. Trauma:

Trauma can also cause damage to the fat pad. There are many factors which can cause trauma to the fat pad and damage the fascia or its integrity. Common mechanisms of trauma include landing on heels after a jump/fall from height, stepping on a sharp stone or excessive heel strike in inadequately cushioned shoes.

Being overweight can also increase the burden on the fat pads, increasing pressure and therefore deterioration of the structures.

How Do You Treat Fat Pad Syndrome?

Fat pad syndrome can be managed using a number of methods depending on the severity, mechanism and presentation of the injury. Common treatment options will include:

Acute Treatment:

  • Anti-inflammatories and icing will assist in pain management.
  • Strapping – to keep the fat pad in place and provide protection for the heel.
  • Foam or gel heel pads to provide cushioning and protection for the heel.
  • Deep heel cups – keep the fat pad in position and provide cushioning of the force.

Long-term Management:

  • A strengthening and stretch program supplied by your podiatrist to remedy structural issues within the foot.
  • Supportive footwear which provide firm heel cushioning.
  • Custom-made orthotics to remedy gait and provide structural support and stability to the foot.

Your podiatrist can help to differentiate fat pad syndrome from plantar fasciitis or more serious conditions like calcaneal fractures.

Do I need a Referral to See a Podiatrist?

Generally, no you do not need a referral to see our Pivotal Motion Podiatrist. Though referral may occur via a physiotherapist or GP when podiatry issues are reported, you do not require any paperwork to book a standard appointment.

Referrals will be necessary if you are attending as part of an Enhanced Primary Care treatment plan or bill through WorkCover, DVA or Third Party. These instances can be articulated when booking an appointment and our reception staff will be able to direct you on the best course of action and material required.

How do I Book a Podiatry Appointment for Fat Pad Syndrome?

As with many podiatry issues and injuries it is important to get fat pad syndrome attended to quickly to improve management and functional outcomes. If you think you are suffering Fat Pad Syndrome or have other issues with your feet, book on our online booking gateway or call 07 3352 5116.

 
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