Thinning of Fat Heel Pad

Over the last 5 months I have been bothered with pain in my heel which was originally diagnosed as Plantar Fasciitis but is now been recgnised as fat pad syndrome. Every time I try and run i end up with sharp pai in the heel and afterwards imflammation occurs and is painful to walk on. I am away to be referref for orthiopedic treatment but can anyone tell me any stories of complete recovery for this or is it likely to end my running career. Been stretching religiously over last few eeks, calves, hamstrings but the minute I run again it sets the pain off again


  • The information on google is vague. Some sites say recovery will happen but others are less infomrative. I had 3 weeks complete rest from running but still had some intermittent pain in the area.

  • If it definitely is heel fat pad syndrome then you could consider switching to forefoot or midfoot striking. This has to be gradual. But if it is PF then forefooting might add more strain. There is also a risk that it switches the site of injury from one to another. But if you already have the injury it could be worth considering, especially if the alternative is to stop running.

    FYI I've gradually switched to forefoot over a year or two, so it can be done. Initially, even a k trashed my calves. Now I can run a whole marathon forefoot. I don't claim it is more efficient - just a different mix of pluses and minuses.

  • I have altered my strike gradually from a heel strike to a mid foot over the last couple of months and when they did a gait analysis they seemed to be happy enough with my running pattern. I had stopped running for 3 weeks but I knew the injury had not fully healed so when I went on the treadmill it aggravated it again slightly, not to the extent I had it when I first stopped but enough to cause more discomfort. Ive read though that if the fat pad is damaged there is not really a lot to do so am preparing myself for the worst image

  • in the same boat here Gavin, suffered since xmas and stupidly did London on it last week thinking it would be fine after two weeks rest previous to it.

    Physio and Pod seem to say its the same thing. Doctors useless as its not a 'medical condition' in his medical book, only a sporting injury so ive been referred to a biomechanics and foot injury clinic on the NHS in a couple of week. Wierd thing is when i run i dont always get the pain until after a number of miles but get awful aching pain a few hours after. Ive tried taping, cupping, all sorts but not getting much luck really.


  • Sounds very similar to me. I was due to run the Edinburgh Marathon at the end of May  but had to pull out because I couldn't do the training as it got worse and worse. ive been referred to Orthopedic Services through my work medical insurance so should be seen in next couple of weeks. Had 4 weeks complete rest and just started doing slow running again, still feel it, not nearly as bad though but the Physio said I should try and see how I get on. Some people say it will recover in about 4-6 weeks but I just don't know. Ive tried the same as you heel cups, insoles but they haven't really solved the issue. Stretching the calves, hamstrings and glutes every day has definitely made a difference as well as taking Ibuprofen. Have you tried all this? Let me know how you get on.

  • I was diagnosed with this - Rest was all that was recommended.  Mine literally "went away" although I focused more on cycling than running I also HTFU and got on with it.

    I had heel pads.  Soft shoes - adidas boost would be lovely I guess.   

    I also had acupuncture can't say it did much in hindsight but seemed good at the time!

  • I overpronate so have always used supported shoes and they've worked well to be honest. I have managed to start promoting more of a mid foot as opposed to a heel strike which I hope can make a difference.

    Toto how long did you have to rest from running  before it went away. I have some days where I feel virtually nothing and then I can random spates of mild pain. Was it the same for you?

  • Have you tried the Hoka shoes? They feel well padded. Have only worn them for half an hour but decided to go for something more minimalist.

  • No I use the Brooks Vapours with plenty of cushioning. Going minimalist may be the way forward. However, went to see a foot specialist yesterday on the High Street, got a proper orthothic, tried it and pretty much got instant relief. I had only tried gel based on the shelf insoles which did no good at all. Fingers crossed this will get me back to where I want to be. Looking good so far image

  • Done the usual stretching yeah but not sure if its made any difference or not. Been icing it and ibuprofen but am just resting it now with no impact sports for a few weeks until the appointment. Recently got a new road bike so will be using that quite a bit to keep the cardio fitness up.


  • GM - How long will you have to wear the orthothics for? BTW Also had to learn to keep mileage down as hurt calf badly trying to keep up long distance running.

  • Not sure perhaps long term. I didnt get them from the orthopedist Ive been referred to, I bought from a high street foot specalist store. They may not be a logn term solution but at least they have got me back running so for now thats ok. Im due to see a Orthopedist in next few weeks but I can walk pain free now without the insoles but been advised to wear them all the time for first week, break them in then use just for running.

  • Just be aware that orthos can "transfer" pain to other areas if worn "for ever". Had friends who suffered from back pain (wearing orthos for 2 years) and knee pain (wearing orthos for 10 years - and had them changed regularly!). The injury they were recovering from had already healed but they were scared to let go of the inserts. When they did get rid of their orthos, they no longer suffered from their original injury nor anything else. These are my 2 experiences and have heard other runners tell me similar stories.

    So get advice on length of usage time....and perhaps look at changing your gait for a long term solution.

  • I have had Planta phaciitis for 7 months and have orthotics, done stretching, icing etc. the pain now is only in the heal. Went to Physio yesterday to be told the PF has gone and I now have Heal PaAd syndrome

    Told to ice massage and antiinflams. 


  • PhilPubPhilPub ✭✭✭
    Gavin McLennan wrote (see)

    originally diagnosed as Plantar Fasciitis but is now been recgnised as fat pad syndrome.

    These aren't mutually exclusive.  Or to put it another way, I've had the same problem, which was explained by an NHS physio as fat pad atrophy causing PF.  I'm a bit of a heel striker, nothing dramatic but enough that the lack of fatty pad has put extra stress on the PF where it runs under the heel.  Treatment went something like this:
    - Wearing gel pads to cushion heels.  This appeared to have some (limited) effect and meant I could run at an easy pace
    - Referred to a podiatrist who gave me orthotics, to supposedly do a more effective job of relieving impact on the heel.  Continued to run at an easy pace with no real problems, but heel pain came back with any attempt at fast running
    - Started doing some specific PF stretches which I'd not done before, the most effective of which appeared to be stretching the upper end of calf/back of knee by either pressing toes up against a wall and leaning in (see image 7), or calf drop off a step (image 2), even though the podiatrist didn't recommend the second one as it's harder to regulate the amount of stretch.  (Just ease into this one carefully if you do it.)

    I started doing the stretches a couple of months ago and the problem disappeared within days.  Have been back to full intensity training and racing since then with no real problems.  My fatty pads are still not very fatty, and I've been given the impression that they won't recover, and that I should continue wearing the orthotics.  Indeed, the only time I've noticed any issue whatsoever, and it's been very minor, is after wearing flatter shoes for a race.  (Even with orthotics in.) So continual preventative stretching and wearing whatever footwear the physio/podiatrist recommends seems to be the way forward.

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