Anatomy
Under the heel bone (calcaneus) is a shock-absorbing fat pad (corpus adiposum) to protect the heel bone and the plantar tendon (aponeurosis plantaris) that attaches to the heel bone under the heel.
Heel pad, sole of foot
A. Corpus adiposum
B. M. flexor digitorum brevis
C. M. flexor hallucis longus
D. Aponeurosis plantaris
Cause
‘Inflammation’ (inflammation) of the heel pad often occurs after repeated, heavy loads (e.g. in the landing phase after jumping). The injury is often seen during jumping gymnastics, for example.
Symptoms
Pain when walking and pressure, especially on the edges of the heel pad. In some cases, bleeding may be seen in the heel pad.
Examination
The diagnosis is usually made during a clinical examination where there is pressure tenderness over the entire fat pad under the heel, including the edges of the fat pad. If there is no progress or sudden shooting pain, a medical examination should be performed to make a correct diagnosis.
X-rays and ultrasound scans (possibly MRI scans) may need to be supplemented to establish the diagnosis. Ultrasound scans often show thinning of the heel fat pad (Chang AH, et al. 2022).
Treatment
Treatment primarily involves relief from the pain-inducing activity (jumping). If treatment is started quickly, the injury can heal in a few weeks in some cases, but symptoms lasting six months are not uncommon. Footwear with a suitably tight heel cup to keep the heel pad in place under the heel and shock-absorbing soles are recommended.
Rehabilitation
The treatment consists primarily of offloading. The principles of rehabilitation for children and adolescents can be followed until pain-free, after which gentle running and jumping can be resumed.
Bandage
Evidence of the effect of tape on inflammation of the heel pad is scarce but can be attempted. See tape.
Complications
If the progression is not smooth, you should consider an X-ray and ultrasound scan (or MRI scan) to rule it out:
- Bone fracture in the forefoot
- inflammation of the holloway foot tendon/fasciitis plantaris
- Morbus Severe/Apofysitis calcaneus
- Periosteal avulsion (periosteal avulsion)
- Tarsaltunnel syndrom
- Tendon synovitis
- Soft tissue tumours (Saad A, et al. 2021).
