Heel Pad Atrophy – A hidden cause of heel pain

When most people experience heel pain, the first condition that comes to mind is plantar fasciitis. It is one of the most common causes of heel discomfort — but it is not the only one. A frequently overlooked culprit is heel pad atrophy, and it is more common than many people realise.

Unfortunately, heel pad atrophy is often misdiagnosed as plantar fasciitis, leading to ineffective treatments and ongoing pain. Knowing the difference is key to finding relief.

What is Heel Pad Atrophy?

Your heel has a natural cushioning system — a thick, shock-absorbing pad made up of fat and connective tissue. This heel pad acts like a built-in shock absorber every time you walk, run, or stand.

In heel pad atrophy, this natural cushion thins or loses its elasticity. Without enough padding, the heel bone and underlying soft tissue bears more impact with every step, leading to pain and tenderness. Over time, the heel pad impact could lead to a further injury of the heel pad, such as fat pad (heel) contusion or bruising.

Causes of Heel Pad Atrophy

Heel pad thinning can happen for several reasons:

• Age-related changes – The heel’s fat pad naturally thins and loses elasticity as we get older.
• Overuse or repetitive impact – High-impact activities like running, jumping, or long hours on hard surfaces.
• Foot biomechanics – Foot types with poor function such as flat feet, or high arched feet.
• Inappropriate footwear – Wearing shoes with inadequate cushioning or support.
• Injury – Previous heel trauma can cause damage to the fat pad.
• Medical conditions– Rheumatoid arthritis, diabetes, or connective tissue disorders can contribute to break down of fat and collagen in the fat pad.

Symptoms – How It Differs from Plantar Fasciitis

While both conditions cause heel pain, there are some tell-tale signs of heel pad atrophy:

• Pain is central in the heel (directly under the heel bone), not just along the arch.
• Pain worsens when walking barefoot or on hard surfaces.
• A “bruised” feeling when standing for long periods.
• Reduced heel padding you can feel when pressing under your heel – may feel like you are walking on “bone.”

Diagnosis – Spotting Heel Pad Atrophy

Our Melbourne podiatry clinic uses a combination of clinical examination (including footwear and gait assessments), palpation tests, and sometimes diagnostic imaging to assess heel pad thickness and rule out other causes of heel pain. This step is crucial — treating the wrong condition delays recovery.

Treatment Options for Heel Pad Atrophy

While heel pad atrophy cannot be reversed completely, the pain and stress on the heel can be reduced with the right management:

• Custom orthotics with specialised heel cushioning, addressing the foot biomechanics, to further protect the heel pad.
• Shock-absorbing heel cups or inserts to mimic lost padding. Strapping may also help in the short term.
• Appropriately recommended footwear advice for everyday wear.
• Activity modification to reduce high-impact stress.
• Targeted strengthening and mobility exercises for foot and ankle health.
• CAM Walker may be required for short term pain relief in more severe cases.

Why Choose Melbourne Podiatrists & Orthotics for Heel Pad Atrophy?

At Melbourne Podiatrists & Orthotics, we take the time to accurately diagnose your heel pain — because a “one-size-fits-all” approach does not work for feet. We use thorough assessment methods to distinguish between plantar fasciitis, heel pad atrophy, and other causes of plantar heel pain.

By tailoring your treatment plan to the actual cause of your pain, we can help you get back to walking, exercising, and living without constant discomfort.

Heel pain not improving?

At our Melbourne foot clinic our podiatrists are experts in plantar heel pain diagnosis and treatment.

So if your heel pain has not improved with standard plantar fasciitis treatment, it might be something else. So best to book an appointment with one of our friendly podiatrists today!