Heel Pad Syndrome

Heel pad syndrome can cause severe heel pain, making it difficult for you to stand, walk, or run. In this guide, we tell you all you need to know about the symptoms, causes, diagnosis, and treatment of heel pad syndrome. We also introduce you to some stretches and exercises to relieve your heel pain and prevent heel pad syndrome from returning.
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Juhi Modi Medical Writer
Medically reviewed by 

Content:
What is heel pad syndrome?
Symptoms
Causes
Pain relief and treatment of heel pad syndrome
How to prevent heel pad syndrome in the future?
When to see a doctor about your heel pad pain
Heal that heel pain

There’s a deep pain in the middle of your heel. It feels like a bruise, but you can’t see anything wrong on the surface. Yet, you find it difficult to run or even stand for long periods of time. Walking barefoot, especially on hard surfaces, is very painful.1

If any of the above symptoms sound familiar, you could be suffering from heel pad syndrome. Luckily, this is a treatable condition that can improve with exercise. But, your heel pain could also be due to other causes. How can you tell what’s causing your pain? And what can you do to treat your heel pad syndrome?

In this informative guide, we help you understand the symptoms, causes, and treatment of heel pad syndrome. We also explore how it is different from other causes of heel pain. Last but not least, you’ll learn some rehab exercises that can make your symptoms better.

Looking for a solution to heel pad syndrome? Try the Injurymap exercise app now.

What is heel pad syndrome?

Heel pads are shock-absorbing cushions in your heels. They are made of adipose tissue (fat) and tough, but flexible muscle fibers. When you stand, walk, jump, or run, your heel pads absorb the shock of the impact. They distribute your body weight and protect the bones and joints of the foot.1

As you go about your daily activities, your feet undergo wear and tear (damage due to normal use and aging). This is similar to the tread of a tire wearing off with use. Some wear and tear of the heel pads is expected over time. However, too much wear and tear can cause your heel pads to shrink in size. The medical term for this is atrophy. The thinned heel pads lose their elasticity and shock-absorbing capacity.1

The condition is called heel pad syndrome or fat pad atrophy. It is caused by a thinning of the protective cushions in the heel. Heel pad syndrome is one of the most common causes of heel pain.2

Symptoms

The symptoms of heel pad syndrome develop due to thinning and loss of elasticity in the cushioning pads of the heels. The main symptom of heel pad syndrome is a deep pain in the mid-heel that feels like a bruise.

The heel pain is typically worse when you stand, walk, or run. You may not feel the pain all the time. For example, it may only be noticeable when you walk barefoot on a hard surface or go for a run. You will often feel the pain, if you press your heel with a finger. The pain, inflammation, and tenderness caused by heel pad syndrome can be present in one heel or both heels.1

Causes

The main cause of heel pad syndrome is wear and tear (damage or injury due to repeated use).3 This leads to shrinkage of the fat pads and symptoms of heel pain. Various factors can contribute to the wear and tear of the fat pad, including:1

  • Age: As you grow older, your heel pads lose some of their natural elasticity.
  • Obesity: Excess body weight places stress on the heel pads, causing them to break down over time.
  • Anatomy: If your manner of walking or the structure of your foot result in an uneven distribution of weight on the heels, one of your heels or parts of the heel pad may wear down more quickly.
  • Activities: People who take part in activities like running, gymnastics, or basketball repeatedly strike their heels on the ground with great force. This can lead to damage and can trigger heel pad syndrome.
  • Footwear: If you walk or run barefoot, your heels are subjected to stronger forces compared to people who wear well-cushioned shoes. Poorly cushioned footwear can increase your risk of heel pad syndrome.
  • Surfaces: People who frequently walk or run on hard surfaces are more prone to develop heel pad syndrome due to increased wear and tear of the fat pads.
  • Medical Conditions: Certain diseases such as diabetes, rheumatoid arthritis, and lupus can contribute to heel pad shrinkage.
  • Heel Spurs: Heel spurs are bony overgrowths on the underside of the heel. They can reduce the elasticity of your fat pads and contribute to your heel pain.
  • Plantar Fasciitis: This is a condition in which the plantar fascia (a tissue that extends from the heel to the toes) becomes inflamed. It can lead to a quicker deterioration of the fat pad in the heel.

Difference from other similar heel conditions

Several foot conditions can cause heel pain. It is often difficult to tell which condition is causing your heel pain because the symptoms are very similar.

Plantar fasciitis is the most common cause of heel pain.2 It is an inflammation of a band of tissue called the plantar fascia. The plantar fascia extends from the heel to the toes.2 The heel pain from plantar fasciitis has certain unique characteristics. It is often only present in one of your feet, where it is located on the inner side of the heel. It typically occurs with the first weight-bearing step when you get out of bed and after long periods of rest.

Heel pad syndrome, on the other hand, causes an aching, tingling, burning pain that can be present at night. The pain is often present in both heels and is typically worse after a long walk.2

Another cause of heel pain is a calcaneal stress fracture. This is a hairline crack in the heel bone (calcaneus).5 It causes heel pain after you change your activity level or walk on a hard surface.6

Heel pain due to a calcaneus stress fracture tends to worsen progressively. It may initially be present only with activity. Later, you may experience heel pain at rest. It may also cause swelling around the heel.1

Pain relief and treatment of heel pad syndrome

    There are several exercises and stretches you can do at home to ease the symptoms of fat pad atrophy.The Injurymap app shows you how to do these foot exercises correctly. If you are overweight, you can also use the app to follow a whole-body exercise program that can help you lose weight. Being overweight is a known cause of heel pad syndrome. Here are some exercises that can help you with your heel pain:

  1. Toe stretch
    10 reps

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    Toe Stretch

    • Sit on a chair with your heels on the floor and the front part of your feet lifted up slightly.
    • Slowly bend your toes, and then extend them out as far as possible.
    • Repeat the movement 10 times in both directions.
  2. sitting foot stretches I
    10 reps x 3 sets

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    Sitting Foot Stretch

    • Sit on a chair with your legs bent.
    • Place the exercise band under the foot just behind the toes.
    • Grab the exercise band with one hand and tighten it.
    • Move your foot up and down while holding the exercise band to create resistance in the downward movement.
    • Go as far as possible in both directions.
    • Perform 3 sets of 10 repetitions with each leg.
  3. Heel lift with bent knees I
    5 reps

    This browser does not support the video element.

    Heel Lift with Bent Knees

    • Stand with your feet slightly apart.
    • Your toes should point straight ahead.
    • Slowly move your knee past the toes so that your ankle and knee bends.
    • Move the knees forward as far as possible, so that the ankle is bent to a maximum.
    • You should feel it tightening in the back and front of the ankle, but it should not hurt.
    • Keep your knees bent while slowly raising your heels, so that you're standing on your toes.
    • Hold your balance for a few seconds then slowly lower your heels again.
    • Perform 5 repetitions.

Other pain relief options

Rest, ice, and pain medications: If you have symptoms of heel pad syndrome, consider taking a break from intense athletic training, such as long-distance running. Icing the heel can also relieve pain. Short-term use of pain medications, such as ibuprofen or acetaminophen, may help.7

Taping: Temporary athletic taping of the heel fat pad can provide more cushioning under the heel and reduce pain.7

Footwear modifications: Custom-molded shoes, heel cups, and cushioned socks with extra padding can support the feet and reduce the impact on the heels.8

Recovery time

Fortunately, most people recover from heel pad syndrome with conservative treatments, including exercise. Like most conditions that result from wear and tear or overuse, rest can help your feet rebuild and repair the fat pad in the heel. You can speed up your recovery by performing stretching and strengthening exercises. Low-impact weight-bearing exercises are advisable while you heal.

How is heel pad syndrome diagnosed?

Doctors make a diagnosis of heel pad syndrome based on the symptoms you describe and your physical examination. Your physician may order an X-ray or ultrasound study of your foot to diagnose fat pad atrophy or rule out other causes of heel pain.1

Doctors can measure the thickness of your heel pad on imaging studies. Normal heel pads are 1-2 cm thick. A fat pad that measures less than 1 cm in thickness is considered atrophied.8 To assess elasticity, your doctor may compare the heel pad thickness when you’re bearing weight to when you’re not.1

Complications

Untreated heel pain can be disabling, making it difficult for you to walk, play sports, and be productive at work. Heel pain can also change the way you walk, making you susceptible to falls and injuries.9

How to prevent heel pad syndrome in the future?

You can do several things to reduce your risk of developing heel fat pad atrophy:10

  • Exercise regularly and maintain a healthy body weight (excess body weight is a known risk factor for heel pad syndrome).
  • Avoid activities that place excessive pressure on the heels, such as walking barefoot on hard surfaces or running long distances on uneven surfaces.
  • Wear comfortable, well-cushioned footwear that absorbs shock and supports your heels.
  • Use insoles or shoe padding to distribute your body weight equally and minimize the impact of walking or running.
  • Build strength and flexibility in your feet with regular exercise.

When to see a doctor about your heel pad pain

Most people can manage heel pain due to fat pad atrophy with home remedies and exercise.

See a doctor if:11
  • You have severe pain.
  • You have swelling or redness in your heel.
  • You are unable to walk due to heel pain.
  • Your pain does not improve after a few days of conservative home treatments.

Heal that heel pain

The symptoms of heel pad syndrome can be severe and unbearable for both athletes and non-athletes. The heel pain can keep you from running or leading an active lifestyle. Fortunately, you can treat your pain from heel pad syndrome at home with stretching and strengthening exercises.

The Injurymap app shows you several exercises to help you recover from heel pad syndrome. These exercises will relieve your pain. They will also help to build strength and flexibility and prevent the problem from recurring. Best of all, you don’t need to buy any expensive gear or cough up for a pricy gym membership. You can perform all the exercises in the convenience of your home with minimal equipment. The app shows you the correct technique to do each exercise.

If you have heel pain due to fat pad atrophy, start by doing some gentle stretches. Then, gradually scale up your workout to include strengthening exercises. Try the Injurymap app today. You’ll find it is a convenient and cost-effective way to stay in shape and speed up recovery from heel pad syndrome.

Start your 14-day free trial of the Injurymap app today!

References:

  1. https://www.healthline.com/health/heel-pad-syndrome#symptoms ↩

  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309235/ ↩

  3. https://www.merriam-webster.com/dictionary/wear%20and%20tear ↩

  4. https://www.webmd.com/pain-management/heel-spurs-pain-causes-symptoms-treatments ↩

  5. https://www.sportsinjuryclinic.net/sport-injuries/foot/heel-pain/calcaneal-stress-fracture ↩

  6. https://www.aafp.org/afp/2011/1015/p909.html ↩

  7. https://fpnotebook.com/ortho/Foot/HlPdSyndrm.htm ↩

  8. https://lermagazine.com/article/management-of-painful-plantar-fat-pad-atrophy ↩

  9. https://www.healthline.com/health/heel-pain#complications ↩

  10. https://www.mortonsneuroma.com/blog/fat-pad-atrophy-foot/ ↩

  11. ahttps://www.healthline.com/health/heel-pain#see-your-doctor ↩

Treat your pain with Injurymap

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About the author

Juhi Modi has two decades of experience as a medical writer with varied interests and an enduring passion for health, biology, and science. She uses her educational background in medicine to write science-backed articles for clients around the world.

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References:

  1. https://www.healthline.com/health/heel-pad-syndrome#symptoms ↩

  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309235/ ↩

  3. https://www.merriam-webster.com/dictionary/wear%20and%20tear ↩

  4. https://www.webmd.com/pain-management/heel-spurs-pain-causes-symptoms-treatments ↩

  5. https://www.sportsinjuryclinic.net/sport-injuries/foot/heel-pain/calcaneal-stress-fracture ↩

  6. https://www.aafp.org/afp/2011/1015/p909.html ↩

  7. https://fpnotebook.com/ortho/Foot/HlPdSyndrm.htm ↩

  8. https://lermagazine.com/article/management-of-painful-plantar-fat-pad-atrophy ↩

  9. https://www.healthline.com/health/heel-pain#complications ↩

  10. https://www.mortonsneuroma.com/blog/fat-pad-atrophy-foot/ ↩

  11. https://www.healthline.com/health/heel-pain#see-your-doctor ↩