From the Guidelines
Heel pad atrophy is diagnosed through a combination of clinical examination, patient history, and imaging studies, with a focus on measuring heel pad thickness and assessing symptoms such as pain when walking barefoot on hard surfaces. The diagnosis process involves evaluating symptoms, including increased pain in the heel area, especially when walking barefoot on hard surfaces. A physical examination is crucial, revealing a visibly thinner heel pad with decreased elasticity when compressed.
- Key diagnostic factors include:
- Measuring heel pad thickness, with a thickness less than 3-4 mm suggesting atrophy
- Imaging studies, such as lateral foot X-rays and ultrasound, to confirm decreased heel pad thickness
- MRI for complex cases to assess both thickness and quality of the heel fat pad
- Risk factors, including advanced age, long-term corticosteroid use, rheumatoid arthritis, diabetes, and excessive running or high-impact activities However, the provided study 1 focuses on the diagnosis and treatment of heel pain rather than specifically addressing heel pad atrophy, thus it does not directly contribute to the diagnostic approach for heel pad atrophy.
- The diagnostic approach should also rule out other conditions with similar symptoms, such as plantar fasciitis, calcaneal stress fractures, or tarsal tunnel syndrome, through careful clinical assessment and appropriate imaging.
From the Research
Diagnosis of Heel Pad Atrophy
To diagnose heel pad atrophy, a combination of history, physical examination, and imaging studies can be used.
- The diagnosis begins with a history and physical examination of the lower extremity to pinpoint the anatomic origin of the heel pain 2.
- Heel pad atrophy may present with diffuse plantar heel pain, especially in patients who are older and obese 2.
- Imaging studies such as MRI and US can be used to confirm the diagnosis of heel fat pad atrophy 3.
- The plantar aspect of the heel can be evaluated in detail with US and MRI to provide a differential diagnosis of heel pain 3.
- Bedside ultrasound can play a role in defining a specific pattern of heel fat pad atrophy, which can be confirmed with MRI 3.
- Patients with heel pad atrophy may also present with mechanical pain and a constant clunk during footstep 3.
- The heel fat pad can be globally affected or lesion can be observed in the medial aspect 3.