Heel Fat Pad Syndrome - PT

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  Rasoulian, McElfresh, Elliott, Rodriguez                            PT 7539                                   August 2012

                                             Heel Fat Pad Syndrome
                                             A Clinical Management Guideline

  Etiology/ Definition: Heel Fat Pad syndrome (HFPS) is defined as a
  painful, aching condition that affects the protective cushion underlying
  the calcaneus. It is part of a larger group of disorders that have been
  implicated in causing Plantar Heel Pain. Most of the research addresses
  plantar heel pain in general, and HFPS specifically.
               About 1 in 10 individuals will develop chronic
                                                                                    There is currently no
                         plantar heel pain each year.                              specific protocol for the
  HFPS can be a result of several factors, including: Acutely from trauma
  to the calcaneus, chronically due to excessive heel strike with poor heel
                                                                                      treatment of fat pad
  cushioning, or as a part of the aging process in which atrophy of the fat          syndrome; however,
  pad occurs.                                                                         manual therapy and
  Diagnosis/ Clinical Presentation: Patient history is key to properly             exercise for the treatment
  diagnosing heel fat pad syndrome and should include:4                           of plantar heel pain can be
          - Time(s) of day when the pain most frequently occurs
          - Type(s) of footwear used                                              beneficial in terms of long-
          - Type of activity level at work and during leisure time                       term function.
          - Any history of trauma to the calcaneus
  Patient may present with or complain of:2
          - Deep aching pain at the center of the calcaneus
          - Pain at night and resting pain
          - Aggravated by barefoot walking on hard surfaces
          - Complaints of pain after long periods of ambulation or

  Prognosis: As a rule, the longer the period of heel pain symptoms, the
  longer it will take to reach resolution.4 Manual therapy and exercise has
  better long term outcomes versus electrophysical agents and exercise in
  terms of function, but not pain.1

Evidence-Supported Interventions:
Current best evidence suggests that the use of manual therapy and exercise will provide better short and long term outcomes
compared to alternate forms of treatment, including electrophysical agents and exercise.1
   • Mobilization: Mobilization and glides of portions of the foot and ankle, including the plantar fascia, rear-foot, and
        talo-crural joint directed at increasing motion and restoring normal function.1
   • Custom Insoles and Taping: Shoe inserts provide increased padding in symptomatic areas, while taping procedures
        aim to correctly position the pad under the calcaneus in an anatomically correct form.7
   • Corticosteroid Injection: Injection’s for HFPS have shown improvement in pain and function scores initially, but
        recent studies have discovered a correlation between this and long term worsening of related pain.7,17
   • Home Exercise Programs (HEP): Pt education to include discontinuation of symptom increasing activities (high
        impact exercises, etc.) and self-stretching and mobilization techniques. Stretching should focus on lengthening the
        gastrocnemius and soleus, while mobilizations should include ankle eversion and plantar fascia motions.1

   Texas State University                           Dept of Physical Therapy                             DPT7549, 2012	

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