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Mnemonics, Simplified Concepts & Thoughts

Heel Pad Syndrome vs Plantar Fasciitis

Epomedicine, Apr 18, 2025Apr 18, 2025

Last updated on April 18, 2025

Heel pad syndrome and plantar fasciitis both cause heel pain, but they affect different areas and have distinct characteristics.

Further reading and differential diagnoses of heel pain: Heel Pain : Mnemonic

fat pad vs plantar fasciitis
Plantar FasciitisHeel Pad Syndrome
DefinitionInflammation of the calcaneal origin of plantar fasciaTraumatic irritation of the specialized fat that covers & protects calcaneus
PainMedial calcaneal border pain with first steps, aggravated by walking or standingCentral calcaneal pain aggravated by walking or standing
TendernessLocalized tenderness at calcaneal origin of plantar fascia – in the midline or slightly
medial of midline at the origin of the longitudinal arch
of the foot.
Entire bottom of heel is tender (if tenderness if present at calcaneal origin of plantar fascia it is not more painful than the rest of the heel)
Calcaneal compressionPainful (mild)Painless
Heel pad compressionPainlessPainful
Achilles tendon flexibilityMay be limited in cases with duration of 2-3 monthsNormal
Treatment – Initial1. Heel cups

2. Padded arch supports

3. Avoid tiptoeing or pressure across the ball of feet & limit standing/walking

4. Ice application to heel

5. Achilles tendon stretching exercises

6. Massage over heel with rubber ball
Treatment same as for plantar fasciitis from 1-4.

Not much role of physiotherapy
Treatment – Persistent cases (3-4 weeks)1. NSAIDs

2. Taping of ankle & arch to support arch

3. Re-emphasize use of padding
1. Limit weight bearing & continue heel cups
Treatment – Persistent cases (6-8 weeks)1. Obtain foot X-rays

2. Local steroid injection + Immobilization using high-top shoes with soft arch support

3. Repeat injection in 4-6 weeks if symptoms have not improved by 50% + Air cast or short leg walking cast

4. Custom made arch supports (for pes planus or pes cavus)
No injection
Treatment – Chronic cases (3-4 months)Possible surgical interventionNo surgical procedure

Heel pad syndrome: Patients with an uncomplicated heel pad syndrome should have resolution of symptoms and signs within 2-3 weeks when treated with proper padding of the heel. Patients with persistent symptoms should be evaluated for stress fracture of calcaneus, plantar fasciitis, or subtalar joint inflammation.

Plantar fasciitis: Corticosteroid injection combined with padded arch supports and limited weightbearing is successful in approximately 60% of cases. Persistent or recurrent fasciitis (approximately 10% of cases) is seen most often in patients with obesity, with abnormal arch and ankle conditions, with calcaneal spurs greater than 1/2 to 3/4 inch in length, or with jobs demanding prolonged standing or walking on concrete surfaces.

Reference: Office Orthopedics for Primary Care – Treatment, 3rd Edition (Bruce Carl Anderson)

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PGMEE, MRCS, USMLE, MBBS, MD/MS Musculoskeletal systemOrthopedics

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Epomedicine. Heel Pad Syndrome vs Plantar Fasciitis [Internet]. Epomedicine; 2025 Apr 18 [cited 2025 May 9]. Available from: https://epomedicine.com/medical-students/heel-pad-syndrome-vs-plantar-fasciitis/.

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