What's the Difference Between Plantar Fasciitis and Fat Pad Atrophy?

When most people think about heel pain, they assume it's plantar fasciitis. And most of the time, they'd be right.

What Is Fat Pad Atrophy?

However, another condition that can mimic heel pain is fat pad atrophy or heel fat pad syndrome. It’s the second leading cause of plantar heel pain in patients (after plantar fasciitis), accounting for about 15% of all cases.

Normally, the pad of the heel has sufficient fat to protect the foot like a shock absorber when you move. In fat pad atrophy, the heel pad thins, causing pain and sensitivity.

Note: You can have both fat pad atrophy and plantar fasciitis simultaneously. Plantar fasciitis can change the way you walk, leading to fat pad atrophy.

Symptoms of Fat Pad Atrophy

• Deep, bruising, or aching pain in the middle of the heel when you stand, walk, run, or hike
• Pain is recreated when the heel is firmly pressed
• Pain is in both feet
• Pain gets worse after standing, walking, engaging in high-impact activities, or when walking barefoot and on hard surfaces.
• Pain is worse at the end of the day

Causes of Fat Pad Atrophy

Fat Pad Atrophy typically develops and worsens as people age. Here are some other common causes and risk factors:

• People with diabetes – the condition can break down the fat in your heel
• Repeated use of cortisone
• Years of engaging in high-impact activities
• Wearing shoes that don’t absorb impact during exercise
• People with high arched feet
• Trauma to the heel pad
• Plantar fasciitis and heel spurs
• Increased body weight
• Some autoimmune conditions like lupus
• Family history

What is Plantar Fasciitis?

The heel pain in plantar fasciitis is caused by inflammation of the plantar fascia, the foot structure that travels from the heel of the foot and attaches at the base of the toes.

Symptoms of Plantar Fasciitis

• Sharp, stabbing pain in the heel, particularly with first steps out of bed in the morning or after prolonged sitting.
• Pain is closer to the inner part of the heel.
• Pain can be in one heel.
• Pain decreases with movement
• Pain worsens after exercise or standing for long periods of time
• Pain when pressure is applied to heel or arch of foot.

Causes of Plantar Fasciitis

Like fat pad atrophy, plantar fasciitis is also more prevalent as we age, seen more often in athletes such as runners, and in those who are overweight. However, some additional risk factors

• Faulty foot mechanics, such as flat feet and overpronation.
• Tight calf muscles
• Wearing shoes that aren’t supportive (don’t prevent overpronation)

Treatment of Fat Pad Atrophy vs. Plantar Fasciitis

Unfortunately, fat pad atrophy is frequently misdiagnosed and treated as plantar fasciitis. This can explain why treating this condition with exactly the same modalities as plantar fasciitis can fail.

While some of the treatments are the same, it’s critical to be aware of the differences.

Prevention of Fat Pad Atrophy

While you can’t completely prevent fat pad atrophy, there are some things you can do to decrease your risk factors:

• Wear supportive footwear, particularly when engaging in high-impact activities.
• Avoid wearing high-heeled shoes
• Take days off in between high-impact activities to allow your body and feet to recover.
• Avoid walking barefoot, particularly on hard surfaces
• Use a padded mat at work if you stand for long hours such as cashiering.
• Maintain a healthy weight.