What is HFPS?
-
Most plantar heel pain according to Occam’s Razor is plantar fasciitis. Occam’s Razor means that the simplest solution is probably the correct solution. Occam’s Razor allows us to quickly begin treatment when we first see a patient. It creates a fairly accurate Plan A.
This article states that another huge cause of plantar heel pain is HFPS or Heel Fat Pad Syndrome. The article states: HFPS was diagnosed by the following criteria: less than 3 mm heel fat pad thickness assessed by ultrasound, pain at heel center or margin, worsening pain when barefoot or after a long period of standing.
You can readily see by that description that this is different from plantar fasciitis where the pain is more at the MCT, worse in the morning or after sitting, and not bad with barefoot walking unless prolonged.
What if you make a mistake and call HFPS plantar fasciitis? Well, common Podiatric treatment of PF can be helpful for both. We typically tell our patients not to walk barefoot which is bad for HFPS. We design arch supports to shift weight from the heel to arch which can also help HFPS. Taping of the arch usually pushes the heel fat pad around the heel to under the heel helping both diagnoses. All good, right?
Heel Fat Pad Syndrome can be mild, moderate and severe. In mild cases, most of the plantar fascia treatments work well so you may never know that your Working Diagnosis is not right. However, in moderate cases, the patients do not want plastic or just hardness under the heel. These patients can be still treated with custom orthotic devices with deep heel cups 21 mm, 1.5 mm arch fills for higher arches, no rearfoot posts or heel skives, and 3 mm poron heel pads. The severe cases typically know that they don’t have a fat pad right at the start, and a diabetic memory foam device is typically the frame with adjustments for their individual biomechanics.
Plantar Fasciitis and Heel Fat Pad Syndrome are typically very successfully treated. Here is a chart I designed to help you differentiate between them right from the start of treatment.
Differentiating Plantar Fasciitis from Heel Fat Pad Syndrome
Feature
Plantar Fasciitis
Heel Fat Pad Syndrome
Location of Pain
Medial plantar heel at plantar fascial origin
Center of heel directly beneath calcaneus or on sides of heel
Morning First-Step Pain
Common and often severe
Uncommon
Pain After Sitting
Common
Uncommon
Pain with Prolonged Standing
Mild to Moderate
Severe
Pain Walking Barefoot on Hard Floors
Mild to Moderate
Severe
Gait Testing
Toe walking may reproduce pain; heel walking usually comfortable
Heel walking reproduces severe pain; toe walking often comfortable
Pain with Heel Compression (Side-to-Side Squeeze)
Usually Negative
Usually Negative
Pain with Direct Thumb Pressure Under Heel Center
Mild to No Pain
Severe
Pain at Medial Calcaneal Tubercle
Mild to Moderate
Minimal to No Pain
Windlass Test (Jack's Test)
May Reproduce Pain
Usually Negative
Plantar Fascia Palpation
May be tender
Usually Normal
Heel Pad Thickness
Normal
Often Thin or Atrophic
Age Group
Any Adult
More Common in Older Adults
Common Causes
Overload of Plantar Fascia
Fat Pad Atrophy or Repetitive Impact
Best Initial Treatment
Stretching, taping, orthotics
Heel cups, cushioning, shock absorption
