Pain in the heel can affect your daily life and make it harder for you to do everyday activities. As most heel pain is a sign of a foot condition, it’s important to diagnose and begin treating it immediately to prevent it from getting worse.
However, misdiagnosing heel pain can lead to you treating the wrong condition, which is ineffective and may worsen your condition.
Two of the most common causes of heel pain can easily be mistaken for each other. So how do you know if your pain is caused by fat pad atrophy vs plantar fasciitis?
Identifying the cause of your heel pain will help you treat it correctly and reduce the pain. Here’s how to tell the difference between these two common causes.
Fat Pad Atrophy
What Is Fat Pad Atrophy?
The fatty pads underneath the ball of your foot and heel create a protective layer that acts as a shock absorber when you walk, run, and jump. As the pads become thinner, it exposes the nerves and sensitive connective tissues.
As you go about your daily activities, the pressure placed on your foot creates friction between the bones and the connective tissue. This can cause micro-tears to occur, which results in inflammation and pain.
Causes and Risk Factors
Fat pad atrophy is part of the normal aging process and is the most common reason for your fatty pads becoming thinner. As you get older, you lose more of the elasticity in your skin and the fatty tissue.
But several other factors can contribute to developing fat pad atrophy. It’s important to note that this condition affects both men and women equally.
But with that being said, women are more susceptible to fat pad atrophy in the ball of their foot, as women tend to wear tight-fitting footwear and high-heels. High-heels and pointy shoes place the forefoot under excessive pressure, which can accelerate the progression of fat pad atrophy.
Certain medical conditions can also speed up the progression of fat pad atrophy, like:
- Type 2 diabetes
- Rheumatoid arthritis
- Reiter’s syndrome
If you’ve injured your foot or had surgery performed on the foot, you could be at an increased risk for fat pad atrophy.
But you could also be more susceptible to developing fat pad syndrome if it has a family history. You inherit the shape and structure of your feet, which could result in fat pad atrophy.
For example, if you have high arches, the increased pressure and weight on the ball of the foot could speed up the progression of this condition.
Wearing shoes that don’t provide the support that your feet need or that don’t absorb the impact of shock can lead to the thinning of the fatty pads in your feet.
You also increase the risk of developing fat pad atrophy if you spend a lot of time walking on hard surfaces, like concrete.
Taking part in high-impact activities like running, basketball, and soccer where your feet are constantly pounding the ground can lead to wear and tear. This can cause your fatty pad, especially in your heel, to thin, becoming strained and inflamed.
Corticosteroid injections are often used in the treatment of other common foot conditions like Morton’s neuroma, metatarsalgia, and plantar fasciitis.
Unfortunately, one of the side effects of repeated corticosteroid injections into the foot is an increased risk of the fat pad breaking down.
The most common symptom of fat pad atrophy is a deep pain either in the middle of your heel or the ball of your foot.
It may feel like a constant dull ache, but the pain becomes worse with activity. You may even notice a burning sensation that can become more severe when you go about your daily activities.
If you press down firmly on the middle of your heel, you’re able to reproduce the deep pain. You’ll also notice that the foot’s pain worsens when you walk on a hard surface without shoes.
You’ll be able to feel the bones underneath your foot by pressing on them gently, as there’s not much overlying fatty tissue. You may also notice that your heel feels swollen.
As the fatty pad becomes thinner, you’ll find it becomes very difficult to walk barefoot. If left untreated, it can lead to calluses developing underneath the foot.
What Is Plantar Fasciitis?
Plantar fasciitis is a painful inflammatory condition that affects the plantar fascia, a thick band of tissue that runs along the bottom of your foot.
The plantar fascia connects your heel to your toes and supports the arch of your foot. When this thick band of tissue becomes inflamed, you’ll experience pain on the bottom of your foot, close to the heel.
The most common cause for you to develop plantar fasciitis is overuse. But it can also be caused by tight calf muscles that constantly pull on the plantar fascia, overstretching it, or if you’ve injured the plantar fascia.
As you get older, your feet change shape, and the soft connective tissue can lose elasticity; as a result, you can develop the condition.
Plantar fasciitis develops gradually, and in the early stages, you’ll experience mild pain in the heel. As the condition progresses, you’ll experience a sharp, stabbing pain that occurs within the first few steps after getting up in the morning.
The pain usually subsides as you go about your daily activities or during exercise. But it can return after you’ve finished your activity. You may also experience pain after long periods of standing or sitting.
In some cases, you may also experience pain in the arch of your foot.
How to Tell the Difference
Both fat pad atrophy and plantar fasciitis cause heel pain, and fortunately, there are several differences between the two conditions.
The easiest way to tell if you have fat pad atrophy vs plantar fasciitis is to answer a few quick and easy questions about your symptoms!
Where Is Your Pain?
- Center of heel: Fat pad atrophy
- Bottom of heel bone: Plantar fasciitis
Do You Have Arch Pain?
- No: Fat pad atrophy
- Yes: Plantar fasciitis
Is Your Achilles Tendon Also Painful/Inflamed?
- No: Fat pad atrophy
- Yes: Plantar fasciitis
Does The Pain Get Worse With Exercise?
- Yes: Fat pad atrophy
- No: Plantar fasciitis
Do You Have Pain With the First Few Steps in the Morning?
- Yes: Plantar fasciitis
- No: Fat pad Atrophy
Pain at Night or When Resting?
Yes: Fat pad atrophy
No: Plantar fasciitis
You can also do the following quick test to see if the pain in your heel is caused by fat pad atrophy or plantar fasciitis.
Make sure that you have a table or countertop to help you balance. Then stand with your feet shoulder-width apart and your toes pointing forward.
Raise your heels slowly off the ground, keeping your knees extended. Hold the position for 10 to 15 seconds when you’re standing on the tips of your toes.
Lower your heels back to the ground, returning to the starting position.
If the pain in your heel increases, then your plantar fascia is the cause of your pain. When the calf raises, your big toe bends upwards—dorsiflex—which increases the tension on your plantar fascia, causing pain.
If you do the calf raise and notice that there’s no pain or a reduction in heel pain, then your heel pad is causing your pain. When you take the pressure off your heel pad, you won’t feel any pain.