Fat Pad Syndrome

     This is a condition that we don't see too often, it's not specific to runners, triathletes, or training in general, but because it is often mis-diagnosed by doctors I thought it deserved a page of it's own.  It is basically a sore heel - the pain is concentrated over the centre of the heel and it feels like a deep bruise.  Many doctors who don't see a lot of athletic injuries have never heard of Fat Pad Syndrome and, when confronted with pain in the heel region of the foot, will fall back on the diagnosis of 'plantar fascitis'.  I have even seen patients who said their doctor never even looked at or touched their foot, they just wrote a prescription for orthotics and said they have a problem with 'heel spurs'.

The Anatomy

     We were designed to function barefoot.  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 young Kenyans running in their native country or 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 called a 'fat pad' because it's made up primarily of fatty tissue.  The fat pad is kind of divided into sections by ligamentous 'baffles' which help keep the fat pad from spreading out and thereby aid in keeping the cushion where it belongs - under the heel.  Occasionally, the heel can get injured and these baffles can become stretched and then the fat pad spreads out and we lose some of that cushion - which can make weight bearing very uncomfortable.   Fortunately, it is treatable.

Signs and Symptoms

What To Do About It

     Once you can rule out plantar fascitis as a cause of the problem, you can confirm a diagnosis of 'Fat Pad Syndrome' by taping the heel to hold the fat pad underneath the heel.  This procedure is illustrated in the photos below:

heel-tape1.jpg (44715 bytes)

After taping your heel - or having someone do it for you - 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.

So, what do you do now?   Well, fat pad syndrome will heal with time, you just need to try to keep the pain to a minimum while it heals, thereby decreasing the inflammatory process and promoting healing.  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.  Alternatively, you should check your local running specialty store and ask if they carry a 'heel cup' which is 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.

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