Summary
- Damage or atrophy to the fibrous plantar calcaneal fat pad
- Often associated with ageing
- Causes may also be associated with diabetes, rheumatoid arthritis, peripheral vascular disease, trauma and long term corticosteroid use
- Changes in pressure and shear forces can increase the risk of ulceration, particularly with associated neuropathy
Diagnostic tips
- Pain is deep and central on the heel
- Often associated with a blow to the heel such as a fall or stepping on a stone
- Palpation of the heel will allow easy identification of bony structures
Tests and Imaging
- Weightbearing x-ray
- Ultrasound of fat pad to exclude bursitis or other causes of heel pain
- Neurovascular assessment to determine risk profile
Immediate Treatment
- Offloading and cushioning the area
- Analgesia
- Wound care as required
Possible Referral
- Podiatrist will provide padding, offloading, cushioning, footwear modification.
- Dermal fillers have had mixed success.
- Osteotomies or resection of bony prominences may be required.
