Our feet are our key to balance and posture. Our heels are the first point of contact with the ground – in fact, in our lifetime we will walk around the earth five times so it’s important to look after them! 


Plantar heel pain is the most common type of foot pain and makes up for more than 1 million patient visits every year.  


Plantar heel pain is a commonly used term that includes diagnosis like plantar fasciitis, heel fat pad syndrome (HFPS), calcaneal stress fracture, nerve irritation and lumbar radiculopathy.  


Heel pain is predicted to affect up to 7.3% of adults and up to 11% of the middle aged and elderly.  


Prior studies have focused on plantar fasciopathy, even though Heel Fat Pad Syndrome tends to be the second most common cause for plantar heel pain. 


What is the heel fat pad? 

Heel fat pad is a vital structure of the foot as it acts as a shock-absorbing cushion that distributes plantar pressure whilst weight-bearing.  HFPS is likely if an ultrasound shows a fat pad thickness that is less than 9mm.  


Risk factors of heel fat pad syndrome 


-repetitive or prolonged overloads 


-being overweight  

-unsupportive footwear  

-steroid injections 



Management of HFPS and plantar fasciitis includes:  


-modification of activity loads  



-low dye taping 

-gel heel cups 


It is very important that HFPS and plantar fasciitis is diagnosed correctly as the two are treated quite differently. This can be done using x-rays, examining medical history and examining the joints and muscles of the foot and leg. 

Treatment of HFPS can consist of padding the foot with heel cups or improving the biomechanics with the use of orthotics.  

Clinical trials have even tested the possibility of transplanting fat to the heel area.  

Treatment of plantar fasciitis includes icing, cortisone injections, anti-inflammatory medications, supportive shoes, manual therapy, rehabilitation exercises, shockwave therapy, orthotics and night splints.  



Can you prevent HFPS?  

There are many factors that can cause HFPS. Age and genetics are factors we may not have control over but there are plenty of other things you can do to avoid this condition. These include:  

  1. Wearing supportive and cushioned footwear (eg. runners)  
  1. Allowing 24-48 hours of rest between high impact activities  
  1. Avoid wearing high heels as that can put a lot of pressure on one part of the foot  
  1. Avoid barefoot walking, especially on hard surfaces  
  1. Staying in a healthy weight range  


What are the symptoms and differences between heel fat pad syndrome and plantar fasciitis?   

The symptoms of HFPS include pain whilst standing for long periods of time, pain at night, bilateral foot pain and pain when pressing on the centre of the heel.  

On the other hand, plantar fasciitis is often linked with pain during the first few steps in the morning and tenderness when touching the medial calcaneal on the heel bone (as shown in the photo). 

 A CSSM podiatrist can diagnose heel pain and devise a treatment plan. The earlier the diagnosis, the less damage that can occur to your feet.  

And don’t forget you should always try to wear appropriate shoes that provide cushioning for your heels. 




About the author 

Carmen Lim Podiatrist CamberwellCSSM podiatrist Carmen Lim firmly believes that healthy feet equal a healthy life. She understands the vast range of musculoskeletal injuries that occur in the foot and leg and how to deliver the most appropriate and effective treatment approaches for each individual patient. By assessing the cause of pain and designing a treatment plan to prevent future problems, Carmen is motivated to improve every patients’ quality of life.

Whilst knowledgeable in all types of podiatric care, Carmen has a particular interest in sport related injuries and the relationship between foot mechanics and performance or injury.



https://jfootankleres.biomedcentral.com/articles/10.1186/1757-1146-3-17, retrieved on 26/9/22

https://www.physio-pedia.com/Heel_Fat_Pad_Syndrome#:~:text=%2C%20not%20both).-,Although%20similar%20in%20presentation%2C%20the%20pain%20from%20HFPS%20is%20felt,the%20symptoms%20and%20physical%20examination, retrieved on 26/9/22

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6939011/, retrieved on 26/9/22