This is test content. It hasn't been reviewed yet, and will be replaced with reviewed content.

Heel Fat Pad Syndrome

Soft Tissue Conditions· Also known as: heel pad syndrome, fat pad syndromeUpdated Nov 2026

Not reviewed yet: test content

At a Glance

Heel fat pad syndrome happens when the cushion of soft tissue under your heel thins and wears out. It is usually felt as a deep, bruise-like ache in the centre of the heel. Nobody can yet say how common heel fat pad syndrome is on its own. It can feel like plantar fasciopathy, so a podiatrist can help tell the two apart. Simple self-care, such as supportive shoes and easing the activities that aggravate it, is the usual first step.

What is it?

Under your heel bone there is a layer of soft tissue called the fat pad. It sits between your skin and the bone. It works like a cushion: it absorbs shock and spreads pressure across your heel when you walk, stand or run.

In heel fat pad syndrome, this cushion gets thinner and wears out. It usually affects the centre of the heel.

When the pad is thinner, it absorbs less shock. The heel bone then takes more of the repeated knocks from everyday activity. Over time this can lead to bruising, swelling and pain in the heel.

Heel fat pad syndrome can feel a lot like plantar fasciopathy (also called plantar fasciitis), a problem with the thick band of tissue under your foot. The two can look alike, and a clinician can help work out which one it is.

Who does it affect?

It isn't clear yet how many people have heel fat pad syndrome on its own. It may be the second most common cause of plantar heel pain (pain under the heel from any cause), after plantar fasciopathy.

About 1 in 10 people get plantar heel pain, and it is most common between the ages of 40 and 60. Women are twice as likely as men to have it. These figures are for plantar heel pain in general, not for heel fat pad syndrome. About 1 in 10 people get plantar heel pain. It is most common between the ages of 40 and 60, and women are twice as likely as men to have it.

Heel fat pad syndrome is described as more common in older people, people who are overweight, and women. It may also be more common in people who stand on concrete floors for long periods, and in people with diabetes.

Signs and symptoms

The pain usually comes on gradually. It is a dull, deep ache in the centre of the heel, and many people say it feels like a bruise. Pressing on the middle of the heel with your thumb often brings on the same pain.

The ache tends to build the more you stand or walk. It is usually worse when you walk barefoot on hard floors.

The first steps after getting out of bed, or after a rest, are often less painful than they are with plantar fasciopathy, though many people with a thinned pad still get pain with their first steps in the morning. The pain tends to creep up as you keep going.

Pain in both heels is common. Some people also have pain at night.

The ache is usually in the middle of the heel, rather than towards the arch side.

What causes it?

Heel fat pad syndrome usually develops from repeated overuse. Over time, repeated stress on the heel can wear the fat pad down. The pad also thins naturally as you get older.

Several other factors can contribute to heel fat pad syndrome:

being overweight
being over about 30 years of age
shoes that don't support your feet well
long periods of standing or walking, especially if you suddenly do much more than usual
too little recovery time between activities
weak muscles in your feet or legs
tight muscles in the backs of your legs
diabetes
inflammatory arthritis, such as rheumatoid or psoriatic arthritis
long-term use of steroid tablets
repeated steroid injections into the heel

Having one of these doesn't mean you will get heel fat pad syndrome.

How is it diagnosed?

A doctor, physiotherapist or podiatrist can usually diagnose the cause of heel pain by asking about your symptoms and examining your heel. A doctor may also suggest an x-ray, an ultrasound or an MRI scan.

Morning pain doesn't settle it: about 43.2 per cent of people with a thinned pad also have pain with their first steps in the morning. No single symptom decides, so a clinician looks at the whole picture.

Before settling on a diagnosis, a clinician first checks for other causes of heel pain, including:

a stress fracture of the heel bone
a trapped nerve, a problem referred from the lower back, or a nerve growth (neuroma), which may cause burning, tingling, numbness, electric-shock pain, reduced feeling or pain at rest
bursitis (an irritated fluid-filled cushion near the heel)
infection
a tumour
calcaneal apophysitis (inflammation at the growth area of the heel bone)
verrucae or corns

The warning signs are in the 'When to see a podiatrist' section.

Treatment

Treatment starts with simple care you can do yourself.

Looking after it at home

Wear cushioned shoes with good arch support, and consider insoles or heel pads.
Do regular stretching and foot exercises.
Try low-impact exercise, such as swimming.
Stand and walk for shorter stretches.
Avoid high heels, tight pointed shoes, thongs, backless slippers and barefoot walking on hard floors.
If you are overweight, losing weight may help.

See 'When to see a podiatrist' for when to get help.

Treatment from your podiatrist

Your podiatrist can advise on footwear and activity, and show you stretches. These are the standard first steps for plantar fasciopathy.

Heel cups and arch taping are often suggested, but it isn't yet known how well they work for heel fat pad syndrome.

For plantar heel pain in general, orthoses (shoe inserts) give mixed results. They don't seem to reduce pain or improve function in the short term. They may ease pain over the medium term, though it's unclear how much that matters. Custom-made and ready-made types seem to make little difference to pain or function compared with each other.

Other options

If pain won't settle, your podiatrist may suggest shockwave therapy (pulses of sound waves). It can help reduce pain in plantar fasciopathy that hasn't settled. It can cost more and cause more pain or swelling during and after treatment.

A steroid injection isn't suggested early. It can shrink a thinned fat pad further and can rupture the plantar fascia. Ask about the benefits and risks before agreeing to any injection.

Recovery

It isn't clear yet how long heel fat pad syndrome takes to settle, or how often it comes back.

Making changes to your lifestyle and cutting back the activities that aggravate your heel is key to recovery. This is something you can start on your own, and it is up to you to keep it going.

In heel pain in general, women and people with pain in both heels may recover more slowly or less well. It isn't clear yet if the same is true for heel fat pad syndrome, so it doesn't mean your recovery will go that way.

Preventing it

It isn't clear yet whether anything stops heel fat pad syndrome coming back, but these steps may help ease the load on your heel:

Pace yourself: break tasks into parts, take regular breaks and put your daily activities in order of importance.
Build up standing, walking and running gradually.
Allow recovery time between activities.
Keep wearing supportive, cushioned shoes, and avoid walking barefoot on hard floors.

When to see a podiatrist

When to book

Book an appointment with your podiatrist if:

your pain hasn't improved after a few weeks of home care
your symptoms keep coming back
foot pain is stopping you from doing your usual activities
you have pain in one spot on a bone that has built up over a few weeks of running, jumping or other impact, or gets worse if you keep going
you have diabetes or poor circulation and a long-term foot problem, such as a bunion, corns or thick nails

When to get help sooner

Get urgent medical assessment (see your GP today, or go to an urgent care clinic or the nearest emergency department) if:

you have a foot wound, ulcer or infection, or a red, hot, swollen foot, and also have a fever, chills, a fast heartbeat or feel unwell
your foot, or a patch of skin on your foot or leg, becomes red, hot, swollen and painful
your foot or ankle looks badly out of shape, or points at an odd angle, after an injury: go straight away, without waiting for an appointment
you can't put weight on your foot or take four steps after an injury
you feel a sudden snap or pop at the back of your ankle or calf, as if you were kicked, and then find it hard to push off or stand on tiptoe
you have pain in a bone with a fever

See your GP soon if:

you have lost weight without trying
you have had cancer before and notice a new lump, or pain that doesn't settle

See your podiatrist or GP soon if:

you have new numbness, tingling, pins and needles or weakness in your foot that has come on gradually
your pain is getting worse, or doesn't settle with rest, less activity or pain relief

Frequently asked questions

Can I use ice on my heel?

If you like, rest with your foot raised when you can. If you use ice, wrap it in a towel and use it for up to 20 minutes every 2 to 3 hours. Don't ice numb skin, open wounds, or a foot with poor feeling or infection.

Can I keep exercising?

Low-impact exercise, such as swimming, is suggested. Try to stay in the green (sometimes amber) zones of a 0 to 10 pain scale, during exercise and for 48 hours afterwards. Red-zone pain suggests you may be pushing too hard, so ease off if your pain flares.

What should I tell my podiatrist?

Say when the pain started and exactly where it is. Mention whether it is worse first thing in the morning or after long standing, what footwear and surfaces you use, and any steroid injections you have had in the past.