What is the treatment for heel pad syndrome?

Treatment of Heel Pad Syndrome

The treatment of heel pad syndrome primarily involves conservative measures including cushioning heel pads, supportive footwear, activity modification, and NSAIDs to reduce pain and inflammation. 1

Diagnosis and Clinical Features

Heel pad syndrome is characterized by:

• Pain in the center of the heel, particularly with weight-bearing
• Pain that worsens when walking barefoot on hard surfaces
• Thinning or damage to the fat pad cushioning the heel
• Tenderness on direct palpation of the central heel pad

Unlike plantar fasciitis (which causes pain at the medial calcaneal tubercle), heel pad syndrome causes pain directly under the center of the heel.

Treatment Algorithm

First-Line Treatment (0-6 weeks)

1. Cushioning and Support:

   • Custom heel pads with shock-absorbing materials like Sorbothane or Plastazote 2
   • Supportive footwear with adequate cushioning
   • Avoid walking barefoot, especially on hard surfaces 1

2. Pain Management:

   • NSAIDs to reduce pain and inflammation 1
   • Ice application after activity (10-15 minutes)

3. Activity Modification:

   • Reduce weight-bearing activities that exacerbate symptoms
   • Weight loss if indicated 1

4. Footwear Modifications:

   • Open-backed shoes to reduce pressure on the heel area
   • Shoes with thick, cushioned soles 1

Second-Line Treatment (6-8 weeks if no improvement)

1. Orthotic Devices:

   • Custom-molded orthotics with additional heel cushioning 2
   • Medial arch support if biomechanical issues are present

2. Physical Therapy:

   • Stretching exercises for calf muscles and plantar fascia
   • Strengthening exercises for intrinsic foot muscles

3. Immobilization:

   • Walking boot or fixed-ankle walker device in severe cases 1

Third-Line Treatment (if no improvement after 8 weeks)

1. Specialist Referral:

   • Podiatric foot and ankle surgeon consultation 1

2. Advanced Interventions:

   • Platelet-rich plasma injections (emerging treatment) 3
   • Corticosteroid injections (used cautiously as they may further damage the fat pad)

Special Considerations

Pitfalls to Avoid

• Misdiagnosis: Heel pad syndrome is often confused with plantar fasciitis. The key difference is the location of pain (central heel vs. medial calcaneal tubercle).
• Overuse of corticosteroid injections: These may cause further atrophy of the fat pad and worsen symptoms long-term.
• Inadequate cushioning: Insufficient heel padding will prolong recovery.

Monitoring and Follow-up

• Reassess symptoms every 2-4 weeks
• Evaluate footwear for adequate cushioning and support
• Gradually return to normal activities as symptoms improve

Prognosis

Most patients with heel pad syndrome show significant improvement with conservative treatment within 5-8 weeks 2. The condition is generally manageable with appropriate cushioning and footwear modifications, though some patients with severe atrophy of the fat pad may have persistent symptoms requiring long-term use of cushioned orthotics.