What is Fat Pad Syndrome?

Heel Fat Pad Syndrome (HFPS), also known as Fat Pad Atrophy, is a syndrome caused by changes in the elasticity and/or thickness of the heel fat pad. This is frequently caused by wear and tear of the fatty tissues and muscle fibers that comprise the heel pads, resulting in heel pain that can disrupt our daily routine and interfere with our typical activities. Heel pads might shrink in size or lose their flexibility due to excessive wear and strain. This will weaken the heel’s shock-absorbing mechanism. It is thought to be the second most common cause of plantar heel discomfort, after plantar fasciitis. It is sometimes mistaken as Plantar fasciitis, and while both can cause heel pain, the risk factors, symptoms, and therapy for each condition differ.

The heel can absorb 110% of the body’s weight when walking, and 200% of the body’s weight when running, a chronic rise in pressure striking and load forces may result in thinning of the heel fat pad, resulting in a common complaint of heel pain.

RISK FACTORS AND CAUSES:

Overuse, damage, atrophy, or tension on the fat pad can all cause it. The two most important contributing factors to heel fat pad syndrome are the position of the arch of the foot and the gait or biomechanics.

Some of the most common causes of heel pad syndrome are as follows:

• Inflammation of the Fad pad: Inflammation of the fat pad can occur when it is repeatedly or for an extended period of time subjected to force or pressure. This is most common in patients who participate in activities that demand a lot of jumping, such as basketball, volleyball, gymnastics, or athletics, among others.
• Displacement or thinning of the heel’s fat pad: The fat pad in the heel becomes misplaced or diminished in a few people. This is common in elderly patients since the normal aging process causes a loss of elasticity in the body’s soft tissue components.
• Force: Walking or jogging barefoot, especially on hard surfaces like concrete or tiles, causes undue strain on the fat pad, producing thinning and straining of the fat pad as well as calcaneus bruising.
• Gait imbalance: Patients with feet that point inwards or outwards may experience heel pad pain because their heel strikes the ground in an inefficient manner when walking or running.
• Overweight and obesity:
• Medical conditions causing fat pad atrophy: Type 2 diabetes, lupus, and rheumatoid arthritis are a few examples.
• Plantar fasciitis: In those with plantar fasciitis, the fat pad may wear out considerably faster than it would otherwise.

SIGNS & SYMPTOMS:

1. severe, bruise-like pain in the center of the heel caused by prolonged walking, running or standing
2. Tenderness.
3. The degree of this pain rises with prolonged walking or standing, especially when barefoot, walking on hard surfaces, or performing any high-impact activity.
4. Pain during the night and pain while resting
5. Usually, only one side heel is painful.

DIAGNOSIS:

To identify fat pad atrophy or rule out other causes of heel pain, an X-ray or ultrasound of the foot will be helpful.

PHYSIOTHERAPY MANAGEMENT:

• Activity Modification: Consider a break from strenuous sports training, such as long-distance running.
• Ice and heat: Apply an ice pack for 20 minutes in every 3-4 hours or after any activity that may cause pain.
• Mobilization: Mobilization and glides of the foot and ankle, particularly the plantar fascia, rearfoot, and talocrural joint, to increase motion and restore normal function.
• Custom Insoles and Taping: Shoe inserts provide extra padding in problematic areas, whereas taping treatments seek to put the pad under the calcaneus in the optimal anatomical location. Custom-molded shoes, heel cups, and cushioned socks with extra padding may help to support the feet and reduce heel impact.
• Therapeutic Modalities:
  1. Extracorporeal shock wave therapy.
  2. Super inductive system.
  3. Then, Combo therapy.
  4. Also, High-intensity laser, etc.
• Home Exercise Programs (HEP): self-stretching and mobilization strategies. Stretching should target the gastrocnemius and soleus muscles while mobilizing should include ankle eversion and plantar fascia motions.
• Improve foot, ankle, and lower leg muscle control: Begin with foot stabilization exercises and weight-bearing calf muscle strengthening exercises. Address any deficits that may be causing abnormal foot biomechanics.
• Address biomechanics foot position and increase neuromuscular control: To help align the lower limb, look for muscular imbalances at the hip and knee. Improve dynamic control around the foot and ankle by working on balance and proprioception.
• Increase load on tissue, adding sport-specific/dynamic exercise: Prepare the foot and lower leg for more explosive motions so that you can gradually return to full function. Include plyometric exercises as well-look as jumping and landing techniques.

MEDICAL TREATMENTS:

• Medication: Over-the-counter pain relievers and anti-inflammatory drugs, Ibuprofen, can frequently assist to alleviate heel pain.
• Injectables: Dermal fillers are various injectable materials that are utilized to thicken the atrophied or misplaced fat pad in the heel.

SURGICAL INTERVENTION:

• Autolipotransplantation: Another more advanced augmentation procedure is fat grafting or autologous fat transplantation. Which involves transferring fatty tissues from one part of the body to another, in this case, the heel.
• Allografting: This entails augmentation of the heel fat pad with fat acquired from another person. This fat graft does not include living cells to ensure that the receiver’s body does not reject it.