Heel Pad Syndrome

Written By: Chloe Wilson BSc(Hons) Physiotherapy
Reviewed By: FPE Medical Review Board

What Is Heel Fat Pad Syndrome?

What Does Heel Pad Syndrome Feel Like?

Common symptoms of fat pad syndrome include:

• Deep, central heel pain or bruise-like pain directly under the heel bone
• Pain with direct pressure to the middle of the heel
• Pain that worsens when walking barefoot or on hard floors
• Aching pain that gets worse the longer you are on your feet
• Pain during high-impact activities e.g. running or jumping
• Slight relief when walking on soft, cushioned surfaces or when wearing cushioned shoes

If you feel like you are “walking on a stone,” that is classic Heel Pad Syndrome.

Unlike plantar fasciitis, heel fat pad pain doesn’t usually hurt first thing in the morning or radiate to the foot arch.

What Causes Heel Pad Atrophy?

Heel fat pad syndrome usually develops when the natural cushioning under your heel becomes overloaded, inflamed, or simply wears out. Common causes of fat pad pain include:

• Overuse or High-Impact Activities:  Repetitive running, jumping, and long periods of standing, especially on hard surfaces e.g  volleyball, tennis, running, basketball, dance and gymnastics.
  
  
• Age-Related Fat Pad Atrophy: As we age, the fat pad slowly becomes thinner and less springy due to a natural decline in collagen and tissue elasticity. 
  
  
• Foot Mechanics: Certain foot shapes, such as flat feet or high arches, can change the way force is distributed through the heel, overstressing the fat pad. Your walking pattern e.g. how your foot strikes the ground  can cause the heel pad to wear down over time.
  
  
• Inappropriate Footwear: Wearing shoes with thin or hard soles, poor cushioning and little arch support increases the impact travelling through the heel.
  
  
• Injury: A direct blow to the heel, such as landing hard on the heel when falling from a height, can trigger inflammation in the fat pad.
  
  
• Being Overweight: Extra body weight increases the load on the heel, speeding up fat pad wear and tear.
  
  
• Other Medical Conditions: Some medical conditions can increase the risk of developing heel fat pad syndrome, such as diabetes, rheumatoid arthritis and lupus.

Diagnosing Heel Pad Pain

Heel pad syndrome is typically diagnosed through a combination of clinical assessment and in some occasions imaging studies.

A foot specialist or physical therapist will check:

• The exact location of your heel pad pain
• Whether pain increases when pressing directly on the middle of the heel
• For pain when squeezing the heel from both sides (positive heel squeeze test)
• Pain patterns on soft vs hard surfaces
• Your footwear, gait, and foot mechanics

Whilst not always necessary, you may be sent for imaging studies:

• Ultrasound or MRI can show thinning or disruption of the heel fat pad
• X-rays rule out fractures or bone conditions

Diagnosis of heel fat pad syndrome is mostly clinical, but imaging is useful for persistent or unclear cases.

Conditions to Rule Out

Not all heel pain is caused by heel pad syndrome, so it is important to rule out other conditions with similar symptoms. Here are the main conditions to consider:

1. Plantar Fasciitis

• Typically causes sharp pain at the inner edge of the heel, especially with the first steps in the morning
• Pain may radiate along the arch, unlike the central bruised pain of heel fat pad syndrome

Find Out More: Plantar Fasciitis

2. Calcaneal Stress Fracture

• A small fracture in the heel bone can mimic deep heel pad pain.
• Often associated with sudden onset pain, swelling, and tenderness that worsens with weight-bearing. 

Find Out More: Foot Stress Fractures

3. Baxter’s Nerve Entrapment

• Compression of the lateral plantar nerve can cause heel pain, burning, or tingling.
• Usually more nerve-related symptoms than fat pad syndrome.

4. Retrocalcaneal Bursitis

• Inflammation of the bursa at the back of the heel.
• Pain is located at the back of the heel, rather than the central underside.

Find Out More: Heel Bursitis

Tip: A clear understanding of pain location, timing, and activity triggers usually distinguishes heel pad syndrome from other conditions, but a professional assessment is always recommended if symptoms persist.

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How To Heal Heel Fat Pad Syndrome

Heel pad pain responds extremely well to structured treatment, especially when started early.

Below are the key evidence-based treatments for pain in the heel pad that we recommend.

1. Cushioning & Protection

This is the number one heel pad pain treatment. Your goal is to recreate the shock absorption your heel pad has lost.

• Use deep heel cup insoles (silicone or gel works best) and cushioned socks to provide extra cushioning for the heel
• Choose cushioned trainers with good support over hard-soled shoes
• Avoid barefoot walking on hard floors

2. Reduce Impact Forces

Reducing the forces going through the heel fat pad temporarily is another vital part of heel pad pain treatment.

• Stay off your feet as much as possible and avoid running, jumping or high-impact exercise. Instead swap to cycling or swimming.
• Reduce standing and walking time on hard surfaces
• Swap hard floors for carpeted areas when possible
• For rigid or high-arched feet, cushioned insoles help redistribute force.

3. Fat Pad Taping Heel

4. Ice

Apply an ice pack to the heel for 10–15 minutes after activity to reduce pain and inflammation as part of your daily heel pad pain treatment.

5. Physical Therapy

A physical therapist can provide a

• Tailored Rehab Program: strengthening and stretching exercises
• Gait Retraining: shortening your stride, encouraging mid-foot loading and improving hip and knee alignment can significantly reduce heel pressure
• Manual Therapy: such as soft tissue work and joint mobilisations to combat any tightness or stiffness and improve foot mechanics

In severe fat pad atrophy, specialist treatment options include gel injections and fat grafting. These are less common heel pad syndrome treatments but may help where the fat pad has significantly thinned.

As a physical therapist who has treated many cases of heel fat pad atrophy, I find early cushioning and load modification make the biggest difference.

Heel Pad Syndrome Exercises

Heel pad syndrome exercises can really help to reduce heel pad pain. While they won’t “regrow” the fat pad, they can really improve load distribution, stability, and shock absorption

a) Calf Stretch

b) Toe Flexor Strengthening

c) Foot Arch Control Exercise

d) Glute Med & Hip Stability Work

Recovery & Prognosis

Most people start noticing improvement within 2–6 weeks of starting these heel fat pad treatments, especially once cushioning and footwear changes are made.

Full recovery from fat pad pain usually takes 6–12 weeks, depending on:

• Severity of fat pad atrophy
• How quickly you adjust your activities
• Whether biomechanical issues are addressed

Chronic heel pad pain can be slower (18+ weeks), but still responds very well to unloading, cushioned insoles, and strengthening.

Ignoring fat pad pain symptoms or continuing high-impact activity can significantly delay healing.

How To Prevent Heel Fat Pad Syndrome

To stop heel pad irritation from returning:

• Wear supportive, cushioned, shock-absorbing footwear
• Replace worn-out shoes frequently
• Avoid walking barefoot on hard surfaces
• Use heel cups if you stand for long periods
• Strengthen your intrinsic foot and calf muscles
• Maintain a healthy bodyweight
• Gradually increase activity levels — avoid sudden spikes

Long-term protection from heel pad atrophy is all about reducing impact through the heel.

FAQs

Fat Pad Syndrome Summary

Heel pad syndrome is a common but often overlooked cause of deep, central heel pain. It is often misdiagnosed as plantar fasciitis.

Fat pad syndrome occurs when the heel’s shock-absorbing fat pad becomes irritated, thins out, or loses cushioning.

Common causes include ageing, repetitive impact, high-impact sports, hard surfaces, poor footwear, and gait imbalances that increase pressure on the heel.

Heel fat pad atrophy typically feels like a deep, central, bruised pain that worsens with walking or standing on hard floors and improves on soft or cushioned surfaces.

The best heel fat pad syndrome treatments focus on reducing heel impact with cushioned shoes, heel cups, taping, physical therapy and heel exercises to support the foot and lower leg.

Most people recover well from heel pad syndrome in a few weeks with the right approach, and preventing recurrence is usually as simple as wearing cushioned shoes, avoiding hard surfaces barefoot, and keeping foot muscles strong.

You may also be interested in the following article

• Common Heel Pain Causes
• Foot Arch Pain
• Bump On Bottom Of Foot
• Foot Pain When Walking

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Page Last Updated: 27th November, 2025
Next Review Due: 27th November, 2027

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