What is Heel Pad Atrophy

Heel pad atrophy is a cause of heel pain. Your heels take much of the impact when you stand, walk, or run. A fat pad under your heel bone protects it and absorbs shock.

The fat pad is made of fat cells that are separated by bands of connecting tissue. Over time, the fat pad can break down and lose elasticity and size (atrophy). This causes heel pain due to decreased cushioning in your heel.

In many cases, the pain occurs in both heels. You may feel an aching or burning pain that gets worse while you are walking or standing. This pain may be worse for athletes who play sports on hard surfaces with high impact on the heel.

What are the causes?

This condition happens when the fat pad under your heel bone breaks down over time.

What increases the risk?

This condition is more likely to develop in people who:

• Are age 40 or older.
• Are athletes who play a sport with jumping and landing on hard surfaces, such as basketball.
• Are runners, especially if they land on their heels first when they run.
• Are overweight.
• Have diabetes, rheumatoid arthritis, or blood vessel disease.
• Have received steroid injections in the heel area.
• Have had trauma to the heel area, such as falling from a height.

What are the signs or symptoms?

The most common symptom of this condition is burning or aching pain in one heel or both heels. The pain may be worse when:

• Walking or standing, especially on hard surfaces or for long amounts of time.
• Walking barefoot.
• Wearing hard-soled shoes.
• Resting at night.
• Pressing on the center of the heel (tenderness).

How is this diagnosed?

This condition is diagnosed based on your symptoms, medical history, and a physical exam. Your health care provider will check your heel pad and see if you have tenderness in the center of your heel. You may also have an ultrasound to confirm the diagnosis and measure the thickness of your fat pad.

How is this treated?

Treatment for this condition includes:

• Reducing your time spent walking, standing, or running.
• Avoiding activities that cause pain.
• Taking an over-the-counter pain reliever or anti-inflammatory medicine.
• Wearing shoes with thick heel cushioning or using a soft shoe insert (orthotic).
• Wearing shoes at all times, even indoors.
• Taping your heels to increase support.
• Losing weight if you are overweight.

Follow these instructions at home:

Managing pain, stiffness, and swelling

• If directed, apply ice to the injured area.
  • Put ice in a plastic bag.
  • Place a towel between your heel and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Raise (elevate) the foot above the level of your heart while you are sitting or lying down.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises as told by your health care provider.

General instructions

• Do not use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. If you need help quitting, ask your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• Give your body time to rest between periods of activity.
• Wear comfortable and supportive shoes during athletic activity.

Contact a health care provider if:

• Your symptoms do not improve or they get worse.

Heel Pad Atrophy Rehabilitation

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching exercise

This exercise improves the movement and flexibility of your calf muscles. This exercise may also help to relieve pain and stiffness.

Exercise A: Gastroc and soleus, standing

1. Stand with the ball of your left / right foot on a step. The ball of your foot is on the walking surface, right under your toes.
2. Keep your other foot firmly on the same step.
3. Hold onto the wall, a railing, or a chair for balance.
4. Slowly lift your other foot, allowing your body weight to press your left / right heel down over the edge of the step. You should feel a stretch in your left / right calf.
5. Hold this position for __________ seconds.
6. Return both feet to the step.
7. Repeat this exercise with a slight bend in your left / right knee.

Repeat __________ times with your left / right knee straight and __________ times with your left / right knee bent. Complete these stretches __________ times a day.

Strengthening exercise

This exercise builds strength and endurance in your foot and may help take pressure off of your heel. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise B: Arch lifts (foot intrinsics)

1. Sit in a chair with your feet flat on the floor.
2. Keeping your big toe and your heel on the floor, lift only your arch, which is on the inner edge of your left / right foot. Do not move your knee or scrunch your toes. This is a small movement.
3. Hold this position for __________ seconds.
4. Return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.