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Heel pad syndrome is a condition that can develop due to changes in the thickness and elasticity of your heel pad. It’s typically caused by wear and tear of the fatty tissue and muscle fibers that make up the cushioned pad on the soles of your feet.

Read on to learn more about the symptoms, causes, diagnosis, and treatment of heel pad syndrome.

Your heel pad is a thick layer of tissue found on the soles of your feet. It’s made up of dense fat pockets surrounded by tough but stretchy muscle fibers.

Whenever you walk, run, or jump, your heel pads act as cushions, distributing your body weight, absorbing shock, and protecting your bones and joints.

You may not realize it, but your heels endure a lot. Because of this, it’s normal for them to wear down a bit over time.

Too much wear and tear can cause your heel pads to shrink in size or lose their elasticity. When this happens, they become less capable of absorbing shock. This is known as heel pad syndrome.

With heel pad syndrome, standing, walking, and other everyday activities can trigger pain, tenderness, and inflammation in one or both heels.

Deep pain in the middle of your heel is the main symptom of heel pad syndrome. When you stand, walk, or run, it might feel like you have a bruise on the bottom of your foot.

Mild heel pad syndrome isn’t usually noticeable all the time. For instance, you might only feel it while walking barefoot, walking on a hard surface, or running. You’ll likely feel pain if you press your finger into the heel of your foot.

Heel pad syndrome is associated with heel wear and tear. Many factors can contribute to the development of heel pad syndrome over time. These include:

  • Aging. The aging process can cause heel pads to lose some elasticity.
  • Foot structure and gait. If your weight isn’t distributed evenly across your heel when you walk, parts of your heel pad might wear down more quickly over time.
  • Excess body weight. Carrying extra body weight puts additional stress on the heel pad. As a result, it may break down more quickly.
  • Plantar fasciitis. Plantar fasciitis makes it more difficult for your heel to absorb and distribute the impact associated with activities such as walking and running. As a result, the heel pad can deteriorate more quickly.
  • Repetitive activities. Any activity that involves the heel repeatedly striking the ground, like running, basketball, or gymnastics, can trigger inflammation leading to heel pad syndrome.
  • Hard surfaces. Frequently walking on hard surfaces can increase risk of heel pad syndrome.
  • Inappropriate footwear. Walking or running barefoot requires your heels to absorb more impact than they would in shoes.
  • Fat pad atrophy. Certain health conditions, including type 2 diabetes, lupus, and rheumatoid arthritis, can contribute to the shrinking of the heel pad.
  • Spurs. Heel spurs can reduce heel pad elasticity and contribute to heel pain.

Your doctor will ask you about your symptoms and your medical history. They’ll also examine your foot and ankle. They might request an imaging test, such as an X-ray or ultrasound, to help diagnose heel pad syndrome or rule out other potential causes of heel pain.

Certain imaging tests may allow your doctor to examine both the thickness and elasticity of the heel pad. A healthy heel pad is typically around 1 to 2 centimeters thick.

Heel elasticity is evaluated by comparing heel thickness when the foot is supporting your weight versus when it’s not. If the heel pad is stiff and doesn’t adequately compress when you stand, it could be a sign of low elasticity. This may help your doctor determine if you have heel pad syndrome.

There’s no cure for heel pad syndrome. Instead, the goal of treatment is to reduce the pain and inflammation caused by this condition.

Your doctor might suggest one or more of the following:

  • Rest. You can avoid heel pain by staying off your feet or limiting activities that cause heel pain.
  • Heel cups and orthotics. Heel cups are shoe inserts designed to provide heel support and cushioning. You can also find orthotic soles designed to provide extra heel support or cushioning. Heel cups and orthotics are available online and at most pharmacies.
  • Orthopedic footwear. Visit a podiatrist or a shoe store specializing in orthopedic footwear to find shoes with extra heel support.
  • Medication. Over-the-counter (OTC) or prescription anti-inflammatory or pain-relief medication can help alleviate pain caused by heel pad syndrome.
  • Ice. Icing your heel may relieve pain and reduce inflammation. Apply an ice pack to your heel for 15- to 20-minute intervals after activities that trigger heel pain.

Heel pad syndrome isn’t the only cause of heel pain. There are other common conditions that can cause pain or tenderness in your heel, such as those described below.

Plantar fasciitis

Heel pad syndrome is sometimes mistaken for plantar fasciitis, the most commonly diagnosed source of heel pain.

Plantar fasciitis, also known as plantar fasciosis, occurs when the connective tissue fibers, called fascia, that support the arch of your foot weaken and deteriorate.

Plantar fasciitis causes dull, aching, or throbbing heel pain. However, the pain is usually closer to the instep and inside part of the heel than with heel pad syndrome, which affects the center of the heel.

Another key feature of plantar fasciitis is that the pain is worse when you stand up after a period of rest, such as first thing in the morning. After a few steps, the pain usually decreases, but prolonged walking may cause it to return.

About 50 percent of people with plantar fasciitis also have heel spurs, which can develop as the arch deteriorates. It’s also possible to have both plantar fasciitis and heel pad syndrome at the same time.

Calcaneal stress fractures

Your calcaneus, also known as the heel bone, is a large bone at the back of each foot. Repetitive movements that put weight on your heel, such as running, can cause the calcaneus to fracture or break. This is known as a calcaneal stress fracture.

Calcaneal stress fractures cause pain and swelling in and around the heel, including the back of your foot just below the ankle.

The pain caused by a calcaneal stress fracture typically worsens over time. At first, you may only feel pain in and around the heel when you do certain activities such as walking or running. Over time, you may feel pain even when your foot is at rest.

Other causes of heel pain

Other conditions can also affect the heel. However, the pain may feel different, or it may occur in a different location than the pain caused by heel pad syndrome.

Other potential causes of heel pain include:

Your heel pad is a thick layer of tissue found on the soles in the rear part of your feet. Heel pad syndrome can develop if these pads lose their density and elasticity.

It typically occurs over time from too much wear and tear, repetitive activities, carrying extra weight, or an uneven weight distribution when you walk.

The main symptom of heel pad syndrome is a deep pain or tenderness in the middle of your heel, especially when you stand or walk. These symptoms are usually manageable with treatment.