The heel plays an important role in shaping the arch and managing the stress of running and walking. The heel bone gives your heel its shape and is the largest bone in the foot. There are also two muscles that extend from the sides of the heel bone. These muscles help move your big toe and your smallest toe.
The heel bone is also the starting point for the Achilles tendon, the largest and strongest part of the body. This significant band of tissue connects the calf muscles to the heel bone. The Achilles tendon then pulls on the heel when the calf muscles flex and let us push up on our toes to jump, run, and walk. Additionally, your ankle and heel work together to shape your foot’s arch. However, the heel has another job, along with the arch, to help your foot distribute evenly the forces applied to it.
On the soles of your feet, there is a thick layer of tissue consisting of dense pockets of fat enclosed in muscle fibers that are firm yet flexible; this is known as your heel pad (corpus adiposum). Your heel pad performs like a cushion to protect your bones and joints when you engage in activities such as standing, walking, running, or jumping.
As you put weight and pressure on your feet, your heel pads also work to absorb shock and prevent strain. Heel pad syndrome (also referred to as heel pad pain) is a condition that causes pain in your heel due to inflammation and / or destruction of the fatty tissue that surrounds your heel bone. It is the second most common cause of foot pain after plantar fasciitis. Moreover, both plantar fasciitis and heel pad syndrome can cause heel pain.
When walking on your toes, if your heel pain increases then that would suggest that your plantar fascia is the source of pain. That is because walking on your toes causes your big toe to dorsiflex (bend upwards) which increases the tension in the plantar fascia. But if you were to walk on your toes and notice a reduction of heel pain, that would indicate that your heel pad is the source of the pain.
Causes & Symptoms of Heel Pad Syndrome
Heel pad syndrome can occur due to overuse, injury, atrophy, or strain on the corpus adiposum. When it comes to heel pad pain, the health of the arch of the foot and the gait or biomechanics are the two biggest factors. The function of the arch of the foot is to help support the foot in correct upright alignment. If the arch is injured or compromised, this places more pressure on the heel pad.
The following causes below are some of the most common causes of heel pad syndrome:
- Inflammation – Inflammation of the fat pad can occur when it is constantly placed under force or pressure repetitively, or for prolonged periods of time. This often happens in patients that perform activities involving a lot of jumping.
- Hard surfaces – Walking or running on hard surfaces such as concrete or tiles, put extreme force on the heel fat pad. This type of pressure on the heel can cause thinning and straining of the corpus adiposum and bruising of the calcaneus.
- Heel spurs – Bony heel spurs can contribute to heel pad pain.
- Thinning of the corpus adiposum – In some people, the fat pad in the heel becomes displaced or thinned. This is common amongst elderly patients since the natural aging process results in a loss in elasticity of the soft tissue structures in the body. The pain is almost always described as feeling like a bruise since the exposed heel bone is bearing a force.
The main symptom of heel pad syndrome is a sharp pain in the middle of your heel that you will notice while you stand to perform your daily activities. When you walk or run, it may feel like the soles of your feet are sprained or bruised. In mild cases of heel pad syndrome, you might find that the pain is not noticeable.
Who gets Heel Pad Syndrome?
Heel pad pain includes a wide number of risk factors due to the importance of its function for our everyday activities, whether they were mild or severe. Some of them include:
Gait problems
Most patients with feet that lean inwards or outwards may suffer from heel pad syndrome because their heel is striking the ground in a sub-optimal manner when they walk or run. The corpus adiposum commonly becomes thinned, worn, or inflamed in the areas where the heel is contacting the ground most forcefully.
Obesity
People that are overweight are at a higher risk of developing heel pad syndrome due to excessive weight. Their body weight puts additional pressure on their feet.
Certain medical conditions
Though less common, studies have shown that certain medical conditions contribute to atrophy of the heel fat pad, causing further heel pad pain. These conditions include diabetes, rheumatoid arthritis, and lupus.
Plantar fasciitis
The corpus adiposum can become worn much more rapidly than it would otherwise, in patients suffering from plantar fasciitis. When the plantar fascia ligament is injured or inflamed, it has reduced ability to distribute the forces from walking or running in the foot. This can lead to extra pressure on the heel fat pad, and consequently, quicker wearing.
How Does Heel Pad Syndrome Affect You? How Serious is it?
Heel pad syndrome can definitely worsen if ever left untreated and can result in chronic heel and arch pain as well as scar tissue. Chronic heel pad pain may cause a change in the way you walk, which can also lead to future complications in your hips, knees, and ankles. When the foot is painful it can most certainly cause other problems to other areas of the lower extremity, therefore, it is important not to ignore this condition and get it evaluated.
Recommended Treatment & Rehabilitation for Heel Pad Syndrome
During a diagnosis for heel pad syndrome, a podiatrist specialist will conduct a detailed physical exam. He or she will also collect a complete medical history to get a clearer view of what caused your heel pad pain. Next, your doctor may order additional imaging tests, such as an X-ray or ultrasound to help assess the thickness and elasticity of the heel fat pad.
A regular and healthy heel pad is normally between 1-2cm thick. To be able to assess the heel’s elasticity, your doctor will compare the heel’s thickness when standing compared to when it is not. The heel fat pad should be pliable and should compress when you stand. If the heel pad is stiff and does not compress, it may indicate low elasticity.
Moreover, your podiatrist should be able to differentiate the condition from plantar fasciitis, which contains a diagnosis similar to heel pad syndrome due to the same types of heel pain.
Therefore, in a patient with heel pad syndrome, the heel pain is usually most concentrated in the middle of the base of the heel, and tender all over the affected heel. However, if the problem is towards plantar fasciitis, you will most likely be experiencing pain in the part of the heel that is nearest towards the toes.
Once a diagnosis was successful, physiotherapy may be further advised. A physiotherapist will design a specific treatment program specific to your condition and goals. Your treatment program will include the following:
- Gait training – Your physiotherapist will train proper ways of how you should walk to reduce any further impact to your heel pad.
- Stretching exercises – Your therapist will help you improve the flexibility of your ankle and heel by teaching you certain exercises that will aid your injured heel pad.
- Strengthening exercises – Your physiotherapist will design specific strengthening exercises to help improve the strength of supporting muscles.
- Pain management – This will include the use of ice packs and heat packs to decrease pain and inflammation while the application of heat will increase blood circulation.
- Iontophoresis – Iontophoresis uses a low-level electric current to treat inflammatory conditions such as arthritis, plantar fasciitis, and heel pad syndrome.
Studies have shown that most cases of heel pad syndrome improve over time (about 1-3 weeks) with conservative treatments, and surgery is rarely needed. As for exercises for your feet, mobility, and strength are essential to keep us moving pain-free. The goal of these exercises is to strengthen the muscles in the feet and calves while improving flexibility in the Achilles tendon and plantar fascia. Here are some exercise examples you can try, including the following:
Heel ups
While in a standing position with the feet close together, place a tennis ball in between the heels and maintain the position of the ball by squeezing the heels together. Afterward, in a controlled motion, raise up on the toes and then return to the start position. Complete this exercise 2 sets of 10 repetitions twice a day.
Standing calf stretch
Stand facing a wall and place your foot up against the wall. With your knee bent, lean forward until you feel a stretch in the calf closest to the wall and hold the position. Complete this stretch 2-3 times a day.
Standing gastroc stretch
Firstly, stand and place both hands on a wall. Secondly, place one leg behind the other, slightly staggered, and lean your body forward without bending the back knee until you feel a stretch in your back calf. Remember to keep the correct arch position in your foot and keep the heel on the ground. Finally, ensure both feet are facing upward before repeating the stretch 2 more times of up to 60-second holds twice a day.
Plantar fascia release
Sit in a chair to help control the pressure put on your feet. Then, take a lacrosse ball and place it under your affected foot. Apply downward pressure on the lacrosse ball with the foot. Next, stay off the heel and ball of the foot, keeping the ball inside the foot. Move the ball under your foot to find tender sports. Once you are on a tender spot, hold the position while applying pressure. Continue to massage for up to 30 seconds before repeating 2-3 times.
Alternative & Homeopathic Treatment for Heel Pad Syndrome
Here are some easy home remedies that can help provide a good degree of relief from pain linked to heel spurs:
Essential oils
Gently massage your heels with this treatment product. Pure essential oils like rosemary or lavender and ever everyday oils such as coconut and olive oil may help reduce pain due to their anti-inflammatory properties. Coconut oil also acts as a natural moisturizer that softens your heels. Just simply warm up the oil slightly and rub it deeply but gently into your affected heel.
Supportive footwear
Try to wear shoes that provide good arch support and have a low heel, especially if you are going to be on your feet more often. This helps to support your plantar fascia and prevent them from becoming inflamed.
Night splints
Night splints help to relieve heel spurs by stretching your arches and calves overnight. These tend to work best for patients who also had plantar fasciitis for at least six months. Most are meant to be used for one to three months and come in both hard and soft models.
Massage
You can perform simple massage techniques to soothe the pain in your heels. Use your thumbs to massage your arches and heels, working from the balls of your feet up to your heel. You may also use a golf ball to massage your arches. Put your foot on the golf ball, hang on to a stable item, and roll the golf ball under your arches.
Ice application
While an ice cube can result in a good massage, an ice pack can also help reduce inflammation. Cover your ice pack with a cloth or thin towel, and hold it over the painful area three to four times daily for 15-20 minutes at a time.
Rest
Sometimes, heel pad pain is a sign that your feet simply need to rest, especially if you regularly do high-impact sports. Giving your feet a break for a few days can help reduce inflammation and let your plantar fascia heal. While you heal, try a low-impact activity, such as swimming.