Recently I had a runner who had suffered with what we thought was plantar faciitis, but instead, after months of time off, therapy from a PT, and seeing his orthopedic a couple of times he was diagnosed with Fat Pad Syndrome.

Since I didn’t know much about this condition I sought help from my anatomy books. This condition is not seen too often, it’s not specific to runners, triathletes, or training in general, but because it is often mis-diagnosed as plantar faciitis, it takes longer to heal.

Signs and Symptoms of Fat Pad Syndrome

  • Pain in the heel, usually a deep, dull ache that feels like a bruise on the middle of the heel. This is in contrast to plantar fascia pain or heel spur pain, which is normally present at the front of the heel, not the middle.
  • Walking barefoot on hard surfaces like ceramic tile, concrete, hardwood floors, etc, aggravates the pain.
  • Pressing with your thumb into the center of the heel should re-create the pain.
  • The condition can often be attributed to a blow to the heel – i.e. landing hard, stepping on a stone while running.

While running shoes have added a lot of cushion and stability to our feet, we could basically run barefoot if we wanted (as evidenced by Zola Budd who raced on the track barefoot). The natural design of the foot is incredible, because not only are the bony arch and the plantar fascia created in such a way as to act as a shock absorber, but we also have about a 1 inch thick pad between our skin and the bone of the heel (the ‘calcaneous’) which acts as a cushion. This cushion is divided into sections by “baffles” which helps keep the fat tissue from spreading out. The heel can get injured, the baffles become stretched and the fat pad spreads out and we lose some of that cushion, which can make weight bearing very uncomfortable.

What To Do About It

Once you can rule out plantar fasciitis as a cause of the problem, you can confirm a diagnosis of “Fat Pad Syndrome” by having a professional tape your heel to stabilize the fat pad, then walk around a bit barefoot on a hard surface and see how it feels. If the pain is decreased or gone, then you have confirmed your suspicions – it’s probably fat pad syndrome.

Fat pad syndrome will heal with time. You could continue to tape the heel with trainer’s tape, however that is time-consuming and can irritate the skin after a few applications. Instead, check your local running specialty shop and ask if they carry a “heel cup” — a little plastic cup that surrounds the heel and presses the fat pad under the calcaneous. It should fit tight around the heel so that when you place you foot in your shoe it compresses the sides of the heel. If a heel cup doesn’t work, then sometimes a heel pad can be added to the shoe for extra cushioning. These are basically little foam or gel pads that soften the blow to the heel but they do not cup the fat pad into place.

You also want to make sure that you ice your heel after exercise, that you wear good cushioned shoes whenever possible, and restrict your exposure to hard surfaces while barefoot. Orthotics may also help, provided that they are designed with a decent heel cup. Anti-inflammatory medication can be useful as well, but the other hints I mentioned are much more effective.

The information contained here is merely that, informational. PRO BIKE+RUN makes no guarantees as to the effectiveness of the treatments stated above. We advise you to seek treatment by a medical professional to truly diagnosis and/or treat any injury or condition.