Massage therapy · Kitchener–WaterlooHeel Fat Pad Irritation/Syndrome

The heel fat pad protects the heel bone by cushioning it and absorbing shock as you move through the day (Chang et al., 2022). Heel pain is sometimes caused by problems with the fat pad. This can happen after forceful, repeated and prolonged activities, such as running, walking or jumping on hard surfaces, or after a single heavy landing (Chang et al., 2022). Long-distance walking and running (especially in hard shoes) are common examples, and people who do a lot of jumping, such as gymnasts, can also have problems here. Thinning of the fat pad is also linked to getting older, diabetes, obesity and some rheumatic conditions (Chang et al., 2022).

Problems with the heel fat pad are sometimes grouped together under the term "heel fat pad syndrome". The exact causes and the best way to diagnose it are still not well established (Chang et al., 2022).

The difficult thing for the doctor or therapist is to accurately diagnose the problem. Heel fat pad problems are often confused with other causes of heel pain, such as plantar fasciitis (Chang et al., 2022), and they can also be similar to heel bone bruising or a small fracture of the heel bone. You may be sent for an X-ray to rule out a fracture, and an ultrasound scan, which can measure the thickness of the fat pad, may help with the diagnosis (Chang et al., 2022).

Heel Fat Pad Irritation/Syndrome Anatomy

The heel bone is known as the calcaneus. Beneath the calcaneus is a soft fatty pad which acts as a cushion for the heel. It is easy to feel: simply press the soft flesh under your heel, and you are pressing the heel fat pad. Sometimes this pad can become irritated and painful, often when too much pressure is placed through the heel, as described above.

How to Treat Heel Fat Pad Irritation

Tips

• Regular gentle stretching exercises may help ease heel pain (NHS, 2025), and specific exercises can help improve movement in the foot and strengthen the surrounding muscles.
• Make sure to follow the instructions provided by your doctor or practitioner to avoid causing further injury to the foot.
• Avoid jumping and landing on your feet from a height.
• Reduce heavy impact (for example, running regularly on hard ground). Vary the types of exercise that you do (for example, runners could add cycling or swimming to their schedule).
• If you are overweight, losing weight may help ease heel pain (NHS, 2025).

Heel fat pad pain usually builds up when the cushion under your heel takes more pounding than it can handle, from long walks or runs on hard ground, lots of jumping, or a single heavy landing. My aim is to take pressure off the heel so it can settle, keep you active in other ways, and build you back up so your feet cope with your activities again.

I start by asking about your activities, footwear and what brings the pain on, then assess how you stand and walk, how your foot and ankle move, and the strength and flexibility of your calf and foot. Fat pad pain can feel like plantar fasciitis or a bruised or cracked heel bone, so if something doesn't fit, I'll ask you to see your family doctor or nurse practitioner.

When It's Sore

• No deep pressure on the tender pad itself; gentle work through the calf, ankle and the rest of the leg instead
• Taping to cushion and support the heel, and I'll show you how to tape it yourself
• Cool applications in the clinic, and I'll show you how to use ice safely at home
• Cutting back the activities that flare it, rather than stopping everything, with swimming or cycling to stay fit
• Help choosing cushioned shoes, heel pads or heel cups

As It Settles

1. Chang, A.H. et al. (2022) 'What do we actually know about a common cause of plantar heel pain? A scoping review of heel fat pad syndrome', Journal of Foot and Ankle Research, 15, p. 60. doi: 10.1186/s13047-022-00568-x. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC9380282/ (Accessed: 7 October 2026).
2. NHS (2025) Heel pain. Available at: https://www.nhs.uk/conditions/heel-pain/ (Accessed: 7 October 2026).