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Fat Pad Heel Injury

Fat Pad Heel Injury: Discussion, symptoms and treatment.

One of the main roles of the heel fat pad is to smooth the effects of loading the body weight onto the foot. Just like the crumple zone in a modern car, the longer the collision takes, the less the forces are.  This is true of a car taking a longer time to ‘crumple’ to a stop against a solid object, and for your body weight to stop its travel towards the ground.

The second is to pad the bony prominences on the bottom of the heel.  As you could imaging, a heel bone, covered only with skin, hitting the ground repeatedly would be prone to damage of both the bone and the skin over it.

What is a Fat Pad?

The fat pad is composed of fat cells (adipose tissue) held within a matrix of fibrous connective tissue a bit like a kitchen scrubbing pad. Similar tissue is all over the weight bearing parts of the bottom of the foot but it is especially thick and resilient in the heel.  Collagen fibres bind the pad into place against the calcaneous / heel bone and the skin and nearby structures.Fat Pad Heel Injury


How does a Fat Pad Injury to the heel occur?                                  

Fat pad heel injuries are usually caused by either a one-off – sudden impact or by repetitive stress to the fat pad. Upon sudden impact or prolonged stress, swelling can occur within the tissue and the layers of the fat pad can separate from each other.  In extreme cases,  the fat pad can displace. This leaves the heel without the proper cushioning it requires and is a very serious, painful and debilitating condition.

Sudden impact fat pad contusions are usually caused by big events such as falls from heights and skydiving.

Repetitive stress to the fat pad is very commonly caused by running, start and stop sports, changes in directions and poor footwear choices, especially when running or under heavier load.


Symptoms of a Fat Pad heel injury

  • Heel pain, often whilst weight-bearing
  • Pain on the outside (lateral) side of the heel at heel strike
  • Tenderness in the posterolateral heel area – this is the weight wearing part of the heel under the outside ankle bone.
  • Pain can be felt by squeeing the tissue
  • Swelling in the area


Risk Factors for a Fat Pad Heel injury.

  • Heavy landing on the heels
  • Long distance running
  • Marching ( eg soldiers)
  • Repetitive jumping


 How is a Fat Pad Heel injury Treated?

  • A fat pad contusion can initially be treated with rest, ice and elevation. A podiatrist should be able to help decrease the pain of  a fat pad heel injury by strapping the area to help the fat pad in place. The condition can take a long time to resolve, depending on the severity of the trauma and you may need to learn how to strap your own heel for convenience.  Your podiatrist can give you a lesson in this technique.
  • The use of pain medication such as paracetamol is generally more useful than anti-inflammatory drugs in the long term.
  • A podiatrist may also be able to recommend a shoe that has a well fitted heel counter as well as lots of cushioning for the heels.
  • Neural Prolotherapy or Perineural Injection Therapy may help to reduce the pain of the condition and can significantly reduce the time taken to recover.  This treatment is available at each of our locations but only with practitioners with additional training.  Please ask when booking.




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