Heel Pad Pain

Heel Pad Pain- General Information

Pain that occurs in the middle of the heel, underneath the foot is referred to as heel pad pain. A fat pad, known as the ‘corpus adiposum’ can be found in this area of the foot. It is there to absorb force and protect the calcaneus (the heel bone) and the arch of the foot from injury due to impact. The corpus adiposum is very thick and dense, making it ideal for its purpose. The fat pad can become thin and worn either in certain places or generally all over, it may atrophy (shrink) over time, or it can become inflamed and painful. This type of heel pain is medically referred to as heel pad syndrome.

Common Signs and Symptoms of Heel Pad Pain

Patients most commonly experience heel pad pain directly underneath the middle of the heel bone. The pain is often described as a deep and dull ache, or a bruise that won’t go away. The pain is almost certainly made worse by walking barefoot, particularly on hard surfaces such as concrete or tiles.

Heel Pad Pain

Causes of Heel Pad Pain

Heel pad pain caused by heel pad syndrome can occur because of overuse, injury, atrophy, or strain on the corpus adiposum. When it comes to heel pad pain, the health of the arch of the foot and the gait or biomechanics are the two biggest contributing factors. When we walk, the feet absorb the impact of more than twice our bodyweight; this force is even greater when we run or jump. If we are barefoot, the force is increased again. The function of the arch of the foot is to support the foot in correct upright alignment. If the arch is injured or compromised, this places more pressure on the heel pad. Your sports podiatrist can assess your foot biomechanics with the use of specialised biomechanical assessment technology on the treadmill, during your consultation.

The following are some of the most common causes of heel pad syndrome:

Inflammation of the corpus adiposum

Inflammation of the fat pad can occur when it is constantly placed under force or pressure repetitively, or for prolonged periods of time. This commonly occurs in patients that are engaged in activities that involve a lot of jumping, such as basketball, volleyball, gymnastics or athletics.

Displacement or thinning of the corpus adiposum

In some patients, the fat pad in the heel becomes displaced or thinned. This is common amongst elderly patients, since the natural aging process results in loss in elasticity of the soft tissue structures in the body. The pain is almost always described as feeling like a bruise, since the exposed heel bone is bearing force.

Force

Walking or running barefoot, especially on hard surfaces such as concrete or tiles, puts excessive force on the heel fat pad. This type of extreme pressure on the heel can cause thinning and straining of the corpus adiposum and bruising of the calcaneus.

Gait issues

Patients with feet that lean inwards or outwards may suffer from heel pad pain, since their heel is striking the ground in a suboptimal way when they walk or run. The corpus adiposum often becomes thinned, worn or inflamed in the areas where the heel is contacting the ground most forcefully.

Overweight and obesity

Patients that are overweight or obese are at greater risk of developing heel pad pain due to heel pad syndrome, since their extra body weight puts additional pressure on the feet.

Medical conditions causing fat pad atrophy

Though it is less common, it is thought that there are some medical conditions that contribute to atrophy of the heel fat pad, causing heel pad pain. These conditions include type 2 diabetes, lupus, and rheumatoid arthritis.

Plantar fasciitis

The corpus adiposum may become worn much more quickly than it would otherwise, in patients suffering with plantar fasciitis. When the plantar fascia ligament is injured or inflamed, it has reduced ability to distribute the forces from walking or running in the foot. This leads to extra pressure on the heel fat pad, and consequently, quicker wearing.

Heel spurs

Bony heel spurs can contribute to heel pad pain since they physically dig into the corpus adiposum.

Diagnosing Heel Pad Pain

Your sports podiatrist will carry out a thorough examination of your feet in order to determine the cause of your heel pad pain and make a formal diagnosis. They will ask you a number of questions regarding any exercise and physical activity you participate in. Your sports podiatrist may suggest a treadmill gait analysis, in order to assess your foot biomechanics, which will give them a greater picture of the overall alignment and function of your feet and legs as you stand and walk. You may be sent to have some medical imaging, such as an x-ray or ultrasound so that they can correctly and accurately evaluate the thickness and elasticity of your corpus adiposum. Your podiatrist may also conduct a physical assessment to check the elasticity of the heel fat pad by comparing the painful heel’s thickness when standing and weight bearing, compared to when it is not weight bearing. A healthy corpus adiposum should be supple and should compress normally when you stand. In patients that have degeneration of the corpus adiposum, or poor elasticity, the heel often appears very flat and does not compress with load.

Differential Diagnosis for Heel Pad Pain: Plantar Fasciitis

The main differential diagnosis for heel pad pain that will need to be ruled out by your sports podiatrist, is plantar fasciitis. Whilst plantar fasciitis can be a contributing factor to heel pad syndrome, it is an entirely different condition. If a patient is suffering from heel pad syndrome, their heel pad pain will be worse in the middle of the heel at the bottom of the foot, and the heel will likely be tender all over. Conversely, if plantar fasciitis is causing the pain, the patient will most likely be having pain in their heel in the area where the plantar fascia ligament attaches to the calcaneus (the part of the heel closest toward the toes and more medially.

What are the differences between the conditions?

Heel pad syndrome

Damage or degeneration of the corpus adiposum causes the heel pad pain. The pain typically feels like a bruise and can be pinpointed in the middle of the base of the heel. Walking on hard surfaces or barefoot makes the pain worse. The pain is easily replicated by pressing a finger in the centre of the affected heel.

Plantar fasciitis

Inflammation due to damage or deterioration of the plantar fascia ligament, is the cause of the pain. The pain is felt in the arch of the foot and at the heel, but in the area closes to the toes, medially, where the plantar fascia attaches to the calcaneus. The pain is usually worse in the morning and can vary from sharp to a dull ache. Pain caused by plantar fasciitis usually improves with rest and the correct stretching regime.

Treatment for Heel Pad Pain

The primary goal of treating heel pad pain is to reduce inflammation. You sports podiatrist may recommend some of the following treatments to relieve your pain, based on your individual condition.

  • Rest by staying off your feet or avoiding activities that cause your heel pad pain or worsen your symptoms.
  • Apply a covered ice pack on sore areas for up 20 minutes at a time, regularly throughout the day or following activities that trigger your heel pad pain.
  • If your heel pad is displaced, your podiatrist can show you how to apply sports tape to hold the heel pad in place and provide more ‘cushioning’ for your heel bone
  • Different types of heel cups, heel pads and orthoses are available that may be recommended by your sports podiatrist. These can either help to secure the fat pad in place, provide extra cushioning, or help with stabilizing the bones of the foot, to in turn contain the corpus adiposum.
  • As a last resort, or in incredibly painful conditions, your sports podiatrist may recommend that you take some NSAIDs (non-steroidal anti-inflammatory drugs) that are available over-the-counter, such as ibuprofen, to reduce your inflammation and pain.

The content regarding heel pad pain in the article detailed above should not be taken as general advice and is for informational purposes only. If you are experiencing heel pad pain, you should consult with an appropriately qualified sports podiatrist to discuss your concerns. Appointments can be made by emailing receptionist@heelclinic.com.au or by calling 82110600.

Karl Lockett – sports podiatrist.