Heel pain that feels like walking on BONE, deep in the middle of the heel, is often fat pad atrophy. The thick cushion of fat under your heel has thinned, so each step lands on less padding.
The fat pad doesn’t grow back on its own. But most people get real relief by putting the cushioning back from the outside: heel cups, soft insoles, supportive shoes and less time barefoot on hard floors.
It’s often mistaken for plantar fasciitis, and that matters. The usual plantar fasciitis fixes, especially a cortisone shot, can make a thin fat pad WORSE.
What the heel fat pad does
Under your heel bone sits a pad of fat about 1 to 2 centimeters thick, held in small tough pockets like a honeycomb. It spreads the impact of every step. When it thins or loses its springiness, the heel bone takes the hit instead.
- Age: the pad slowly loses fat and elasticity over the years. This is the most common cause
- Cortisone injections: steroid injected into the heel can shrink the fat pad, and repeated shots raise the risk
- Years of pounding: running, jumping, or long days standing on hard floors
- Body weight: more load goes through the pad with every step
- Some conditions: diabetes and inflammatory conditions such as rheumatoid arthritis or lupus
- Injury: a hard landing on the heel, or a broken heel bone, can damage the pad. See calcaneus fracture recovery
Fat pad or plantar fasciitis?
- Where it hurts: fat pad pain sits in the CENTER of the heel, right where it hits the ground. Plantar fasciitis is usually toward the inner side of the heel and can spread into the arch
- How it feels: fat pad pain is a deep, bruised ache, like stepping on a stone. Plantar fasciitis is often sharp or stabbing
- When it hurts: fat pad pain builds the longer you stand or walk, especially barefoot on tile or concrete. Plantar fasciitis is worst with the first steps in the morning, then eases as you get going
- What eases it: fat pad pain settles quickly with soft, cushioned footwear. Stretching the arch helps plantar fasciitis more
- Both feet: fat pad thinning more often affects both heels
The two can happen together, so you may need a bit of both approaches. See plantar fasciitis.
What helps
- Heel cups: a soft gel or silicone cup that sits in the shoe. It adds cushioning and gathers the remaining fat back under the heel bone, where it does its job
- Cushioned insoles and socks: a thicker, softer layer under the heel spreads the pressure
- Shoes with a cushioned heel: a firm heel counter at the back holds the fat pad in place. Thin, flat soles make it worse
- No bare feet on hard floors: wear cushioned shoes or slippers at home, including first thing in the morning
- Heel taping: taping that wraps around the heel can hold the pad together under the bone. A physio can show you how
- Swap some impact: cycling, swimming or rowing instead of some running or long walks on concrete
- Ice and simple pain relief: ice wrapped in a cloth for up to 20 minutes after a long day eases flare-ups
The cushion under your heel doesn’t grow back, so you put the cushioning in your shoe instead.
Why cortisone can make it worse
A cortisone shot calms inflammation. But a thinning fat pad isn’t an inflammation problem. It’s a padding problem, and steroid injected into the heel can shrink the fat that’s left. Relief from a shot may fade within weeks, leaving a thinner cushion than before.
If you’ve already had one or more cortisone shots for heel pain and the pain now feels deeper and more “bony”, mention it. It may be the fat pad, not the plantar fascia. See cortisone shot side effects.
Cleveland Clinic has a clear guide to heel fat pad syndrome and how it differs from plantar fasciitis.
When cushioning isn’t enough
- Fillers: some clinics inject a filler under the heel to add volume. The effect is temporary, often lasting months, and the evidence is still limited
- Fat grafting: fat taken from elsewhere in your body is moved into the heel. It can last longer than fillers, but it is a procedure with its own recovery
- Ask what results that clinic gets and what happens if it doesn’t work before you agree to either
If the pain is at the back of the heel instead, see Haglund’s deformity.
Get seen today if
- The heel is red, hot and swollen, or you have a fever
- You have diabetes and notice a new sore, blister, crack or color change on the heel
- You can’t put weight on the foot after a fall or a hard landing
Get it checked if
- You have numbness, tingling or burning in the heel or sole. A trapped nerve can mimic heel pain
- Pain wakes you at night or is there even when you rest
- Pain started after a jump in running and it hurts to squeeze the sides of the heel bone. It could be a stress fracture
- Nothing has improved after 6 to 8 weeks of heel cups, cushioned shoes and less barefoot walking
Plantar fasciitis needs stretching. A thin heel pad needs padding.