From the Guidelines
Diagnosing heel fat pad atrophy primarily involves a combination of clinical examination and imaging studies, with radiography being the initial imaging study of choice, as it can help identify fat pad abnormalities and rule out other causes of heel pain, with a sensitivity of 85% and a specificity of 95% for plantar fasciitis when combined with thickened plantar fascia on radiographs 1.
Clinical Examination
The diagnosis begins with a thorough physical examination where the clinician assesses the heel for thinning of the fat pad, which normally provides cushioning under the calcaneus. Patients typically present with pain in the center of the heel that worsens with prolonged standing or walking on hard surfaces. The pain is often described as a deep, bruise-like sensation. During examination, direct palpation of the heel will elicit tenderness, and the heel pad may feel thinner than normal or less resilient when compressed.
Imaging Studies
Imaging studies are essential for confirmation. While ultrasound (US) and MRI can provide detailed evaluations of soft tissue and directly measure the thickness of the fat pad, radiography is typically the first imaging study performed in patients with a painful heel, including those suspected of having heel fat pad atrophy, due to its ability to identify fat pad abnormalities and rule out other causes of heel pain 1. MRI and US can be used for further evaluation if necessary, especially to rule out other heel pathologies or to assess the integrity of the fat pad in more detail.
Risk Factors and Considerations
Risk factors to consider include advanced age, previous steroid injections in the heel, chronic inflammatory conditions, and repetitive trauma to the heel. These factors can contribute to the development of heel fat pad atrophy and should be taken into account during the diagnostic process. The combination of clinical examination findings and imaging study results, particularly radiography, allows for an accurate diagnosis of heel fat pad atrophy and helps in distinguishing it from other causes of heel pain 1.
From the Research
Diagnosis of Heel Fat Pad Atrophy
To diagnose heel fat pad atrophy, the following methods can be used:
- Ultrasound study: This is a common method used to diagnose heel fat pad syndrome, which can include heel fat pad atrophy 2.
- MRI: This imaging technique can be used to confirm the diagnosis of heel fat pad atrophy, especially in cases where ultrasound is inconclusive 3.
- Bedside ultrasound: This can be used as a preliminary diagnostic tool to identify patterns of heel fat pad atrophy, which can then be confirmed with MRI 3.
Key Findings
The diagnosis of heel fat pad atrophy is important to rule out other causes of heel pain, such as plantar fasciitis. The use of imaging techniques like ultrasound and MRI can help identify the specific pattern of heel fat pad atrophy and guide treatment decisions 3. In some cases, patients with heel fat pad atrophy may present with mechanical pain and a constant clunk during footstep, which can be evaluated using ultrasound and MRI 3.