Heel pad syndrome

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Heel pad syndrome

Heel pad syndrome is pain in the middle of the heel caused by problems with the heel fat pad. It’s more common with age and can be linked to obesity. It’s different from plantar fasciitis, which usually hurts at the front of the heel.

Signs and symptoms
- Deep, dull, bruise-like pain in the center of the heel
- Pain can be reproduced by pressing on the middle of the heel
- Pain worsens with standing or walking on hard surfaces, especially barefoot
- May follow a heel impact or injury

Diagnosis
- The main alternative is plantar fasciitis. In heel pad syndrome, tenderness is across the whole heel; in plantar fasciitis, pain is usually at the front/inner part near the toes and often worse in the morning
- Imaging (ultrasound or MRI) can help: heel pad syndrome may show a thinner heel pad; plantar fasciitis shows a thickened plantar fascia

Treatment
- Rest and avoid activities that worsen the pain
- Pain relief medications as advised
- Cushioning in the heel (heel cups or pads)
- Physical therapy focusing on stretching the plantar fascia and gradual strengthening
- Manual therapy and exercise can improve function over time
- Foot orthoses may not help heel pain; wear supportive, well-cushioned shoes
- Weight management can reduce heel stress
- Most people improve with time, though symptoms can return if stress on the heel resumes