Pain guide · Foot pain
The heel fat pad is the thick cushion under your heel bone that absorbs the shock of every step. Heel fat pad syndrome is pain from that pad: a deep, bruise-like ache in the centre of the heel that builds with standing and walking, especially barefoot on hard floors. Two studies suggest it may be the second commonest cause of pain under the heel after plantar fasciitis, yet it has had very little research: there are no trials of heel cups, taping or exercise for it.
What we do know points to cushioning and holding the heel, pacing your time on your feet, and keeping fit and strong without pounding the heel. This guide shows how to tell it from plantar fasciitis, what heel cups and taping can and can't do, and a staged plan with 3D demos.
Exercise is for pain that has been checked or is clearly mild and settling.
The heel fat pad is the thick cushion between the skin and the heel bone. It is made of fat held in small honeycomb chambers of tough, springy tissue, which absorb shock and spread pressure as your heel strikes the ground. Heel fat pad syndrome is pain from this pad, when it has thinned, lost its springiness, been bruised or become inflamed, sometimes with an irritated fluid-filled sac (bursa) under the heel bone.
The two are often confused, and you can have both. In one clinic study of 250 people with heel pain, pain on long standing, pain at night or pain in both heels made fat pad syndrome far more likely than plantar fasciitis (the odds were 21 to 25 times higher), while pain on the first steps in the morning or tenderness at the front inner edge of the heel made it far less likely. That was one study, which didn't allow for age, sex or weight, so these clues guide rather than decide. NHS pathways and leaflets describe the differences:
Two studies, both found by a 2022 scoping review, suggest it may be the second commonest cause of pain under the heel after plantar fasciitis. In a US study that examined 784 people aged 65 and over at home, 4.2% had pain and tenderness of the heel fat pad, against 6.9% with pain of the plantar fascia. In a Korean clinic's records of 250 people with heel pain, 53% had plantar fasciitis, 15% fat pad syndrome and 9% both. Research is sparse: the review found only 7 original studies of the condition.
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NHS leaflets list being overweight, age, unsupportive shoes, long spells of standing or walking or a sudden increase, diabetes, inflammatory arthritis, weak foot or leg muscles, tight calves, not enough recovery between activities, and long-term steroid tablets. An NHS pathway adds repeated steroid injections into the heel and work standing on concrete, and says it is more common in older or overweight women and with diabetes. These are expert lists: the scoping review found the evidence for causes weak.
An ultrasound can measure the pad, but the findings on thickness conflict, so a measurement doesn't make the diagnosis. The diagnosis is made from the story and an examination; a scan can support it or look for something else, such as a stress fracture, an inflamed sac or a lump. The numbers:
NHS Lanarkshire says most people's symptoms improve, though it can take several months, and most should start to improve within 3 months of following the advice. Bradford's NHS podiatry service suggests contacting your GP or podiatry if there's no noticeable change after 6 to 12 weeks. No study has followed the condition over time.
A 2022 scoping review found 7 original studies of heel fat pad syndrome and no randomised trial of any treatment, and called the usual advice mostly anecdotal. Everything below is NHS service advice, laboratory work or evidence borrowed from plantar heel pain, and each note says which.
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NHS advice for heel pain and fat pad syndrome: shoes with cushioned heels and good arch support, insoles or heel pads, and no long periods of standing, walking barefoot on hard floors, high heels, flip-flops or backless slippers. An NHS pathway's specific advice for a thinned fat pad is a heel pad.
Laboratory work explains why holding the pad in place helps. A firm heel counter (the stiff back of a shoe) increased shock absorption at heel strike by 8.8% on average in 7 people, more in those with poor heel pads; in cadaver heels, confining the pad increased it by 29.5 to 49%. Heel cups smoothed out pressure under the heel, and on X-rays of 6 people with heel pain, a plastic cup raised the pad's thickness from 14.4 to 17.0 mm. In 50 children with Sever's disease, a heel cup increased the pad's thickness, cut peak pressure and eased pain. None of this has been tested as a treatment for fat pad syndrome itself.
In a trial of 236 people with plantar fasciitis, all of whom stretched, the share who improved at 8 weeks was 95% with a silicone heel pad, 88% with a rubber heel cup, 81% with a felt insert, 72% with stretching alone and 68% with a custom-made orthosis. That was plantar fasciitis, not fat pad syndrome, so it supports trying a cheap heel pad or cup first rather than proving they work here.
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In the only study in fat pad syndrome (19 people, 32 feet, no comparison group), walking pain was 6.5 out of 10 barefoot, 4.2 with low-Dye taping (a supportive strapping around the heel and under the arch) and 3.5 with an extra figure-of-eight strap, and peak pressure under the heel fell. NHS Lanarkshire suggests low-Dye taping as a short-term measure, kept on for no more than 3 to 4 days at a time, and an NHS pathway notes that taping can help for a short period.
No trial has tested exercise for fat pad syndrome. NHS leaflets use the same programme as for plantar heel pain: calf and soleus stretches, a towel stretch, heel raises built up over weeks, foot-muscle strengthening, and low-impact exercise such as swimming or cycling. NHS Lanarkshire adds that if stretching makes the pain worse, you should focus on strengthening. Treat it as a sensible way to stay strong and fit while cushioning does the main work, not as a proven treatment.
An NHS pathway says steroid injections shouldn't be a first or second treatment for heel pain. Among their harms it lists thinning of the fat under the skin, nerve injury and rupture of the plantar fascia, and it names repeated injections as a cause of a thinned heel pad.
Fat grafting (moving your own fat into the pad) has been tested in one small trial of fat pad loss under the ball of the foot (25 people), which found better pain and function at a year than usual care. There is no trial in the heel, so it is experimental there.
This site's foot rule: mild to moderate discomfort, no more than about 5 out of 10, that settles within an hour and is no worse the next morning. The 5 out of 10 figure is an editorial starting point.
NHS podiatry services in Lanarkshire and Bradford use a 0 to 10 scale with green, amber and red zones: work mostly in the green, sometimes the amber, during your exercises and for 48 hours afterwards. If you find yourself in the red, you are likely pushing too hard and may flare it up, so pace and space your activity to get back to green.
Your best guide is how the heel feels after standing and walking, and whether that is getting easier week by week (our suggestion). If stretching makes the pain worse, drop the stretches and keep the strengthening, as NHS Lanarkshire advises. The exception: pain in one spot on the heel bone should be pain-free, because it could be a stress fracture.
Start at the first stage. Each move opens a full guide with a 3D demo.
Cushioned shoes with a firm heel counter, and a gel heel cup or pad in every pair you stand in, including slippers. No barefoot walking on hard floors; break up long spells of standing; cycle or swim instead of running or long walks. Low-Dye taping can give short-term relief (the steps are below). Doses come from NHS Lanarkshire's leaflet where marked; the rest are editorial.
3D demoStationary cyclingBeginner · Cardio machine20 to 30 min · NHS Lanarkshire suggests cycling or swimming instead of walking or running; the time is ours
Harder: Air bike intervals
3D demoSeated bent-knee calf raise (soleus raise)Beginner · A bench or box3 sets of 10 to 15 · A seated start towards the leaflet's standing heel raises
Harder: Slow calf raise
3D demoTowel toe curlBeginner · Other / check instructions + A bench or boxGather the towel in, flatten it out, and repeat 3 to 5 times, seated · NHS Lanarkshire's dose
Harder: Short foot + toe splay
3D demoSeated calf stretch with a towelBeginner · Other / check instructions3 holds of 30 s, first thing in the morning · NHS Lanarkshire's towel stretch. Skip it if it makes the heel worse
3D demoWall calf stretch (gastrocnemius)Beginner · A wall3 holds of 20 s each side, in shoes · NHS Lanarkshire's dose
Easier: Seated calf stretch with a towel · Harder: Toes-tucked kneeling (toe squat)
3D demoSoleus wall stretchBeginner · A wall3 holds of 20 s each side, in shoes · NHS Lanarkshire's dose
Easier: Seated calf stretch with a towel · Harder: Toes-tucked kneeling (toe squat)
Move on when: Everyday walking in cushioned shoes is comfortable, and pain after standing is easing week by week.
Strengthen the calf and foot in cushioned shoes, and build up your time on your feet. Doses come from NHS Lanarkshire's leaflet where marked; the rest are editorial.
3D demoSlow calf raiseBeginner · A wallAs many as you can at first, building over several weeks to 3 sets of 10 to 15, in cushioned shoes · NHS Lanarkshire's standing heel raises
Easier: Seated bent-knee calf raise (soleus raise) · Harder: Standing dumbbell calf raise
3D demoHeel raise with a towel under the toesIntermediate · A step + Other / check instructions1 set of 15 every second day, 3 s up, 2 s pause, 3 s down · NHS Lanarkshire's version: on the floor in shoes, not off the step this move's page uses
Easier: Slow calf raise · Harder: Standing dumbbell calf raise
3D demoSingle-leg standBeginner · A wall3 holds of 30 s each leg, in shoes
Easier: Tandem stance and heel-to-toe walk · Harder: Single-leg reach matrix
3D demoElliptical trainerBeginner · Cardio machine10 to 20 min at a moderate effort, building towards 30 · The move's own starting dose; your feet never leave the pedals
Harder: Stair-stepper machine
3D demoTreadmill walkingBeginner · Cardio machineBuild your walking time in cushioned shoes
Harder: Treadmill jogging
Move on when: 3 sets of 15 heel raises and 30 to 45 minutes of walking or standing leave no pain that lingers into the evening or the next morning.
Build towards full days on your feet and, if you run, a gradual return to running. Doses are editorial.
3D demoSingle-leg calf raise from a stepIntermediate · A step + A wall3 sets of 8 to 12 each leg · On flat ground first
Easier: Slow calf raise · Harder: Single-leg pogo hops
3D demoStep-upBeginner · A step3 sets of 8 to 10 each side
Easier: Low step-up · Harder: Dumbbell step-up
3D demoTreadmill joggingIntermediate · Cardio machineWalk-jog intervals on alternate days, if you run · In cushioned shoes, on softer surfaces where you can
Easier: Treadmill walking · Harder: Sprint intervals
3D demoAnkle bounces (mini pogo)Beginner · No equipment2 to 3 sets of 20, landing quietly · Only once the heel is comfortable: this move's page says skip it during acute heel pain
Harder: Pogo hops
Move on when: Keep the cushioning in your everyday shoes. If it hasn't started to improve within 3 months, see a podiatrist, as NHS Lanarkshire advises.
Wear cushioned shoes with a firm heel counter and a deep gel or plastic heel cup, in every pair you stand in, including at home (our suggestion, from the laboratory studies above). Avoid flip-flops, backless slippers, thin or worn soles, and walking barefoot on hard floors.
Note the contrast with a bump at the back of the heel (Haglund's deformity), where a stiff counter is the problem: the fat pad wants the heel held, and the bump wants nothing pressing on it.
Taping can't be shown on the 3D figure, so here are NHS Lanarkshire's steps. Use rigid zinc oxide tape from a pharmacy, and check for a skin allergy first, as an NHS pathway advises. A podiatrist or physiotherapist can show you, and it can help to have someone apply it.
Pacing means breaking up standing and walking with regular breaks, and building up gradually. NHS Lanarkshire and Bradford put it, with weight loss if you need it, at the centre of self-help. Crushed ice in a damp towel for 10 to 15 minutes, 3 to 4 times a day, can ease a flare, as NHS Lanarkshire suggests. Painkillers or anti-inflammatories can help if they suit you.
| Habit or position | Why it matters | Instead |
|---|---|---|
| Walking barefoot on hard floors, flip-flops or backless slippers | They're on the NHS lists of things to avoid with heel pain and fat pad syndrome. | Cushioned shoes or slippers, with a heel cup. |
| Long spells of standing on hard floors | Standing on concrete is linked with it, and the pain builds with standing. | Breaks, sitting for tasks, and a cushioned mat (our suggestion). |
| Thin, flexible or worn-out soles | Flexible soles give less support, and a firm heel counter helps hold the pad in place. | Cushioned shoes with a firm heel counter and a deep heel cup. |
| Heel drops with a firm thud | The move is designed to jar the heel, which pounds a sore pad (our caution). | Slow calf raises in cushioned shoes.Try: Slow calf raise |
| Skipping, running and jumping during a flare | NHS Lanarkshire advises avoiding high-impact activity while it's sore. | Cycling, swimming or the cross-trainer.Try: Elliptical trainer |
| Rolling a ball hard under the heel | Pressing on a bruised pad may aggravate it (our caution), and this move's page says not to roll over a bruise. | Roll the arch gently, or skip it. |
| A sudden rise in time on your feet | Sudden increases in activity are a listed trigger. | Build up gradually, and take your heel cups with you. |
| Repeated steroid injections into the heel | An NHS pathway names them as a cause of a thinned heel pad, and doesn't use injections as a first or second treatment. | Cushioning, taping and exercise first; talk through other options with your clinician. |
A 25-minute standing cardio circuit with no jumping: marching, step jacks, sit-to-stands, punches, step-ups and wall push-ups, with a seated option for most moves.
25 minBeginner9 movesA bench or box, A stepA gentle leg strength routine with no jumping: sit-to-stands, step-ups, wall sits, bridges and calf raises.
20 minBeginner7 movesA bench or box, A stepA 15-minute barefoot routine for stronger toes, arches, calves and ankles, finishing with balance. You need only a towel, a wall and a resistance band.
15 minBeginner11 movesA wall, Other / check instructionsPain from the thick pad of fat under the heel bone that cushions each step: a deep, bruise-like ache in the centre of the heel. The pad may have thinned, lost its springiness or been bruised.
Fat pad pain is central and bruise-like, builds with standing and walking, and is less marked on the first steps of the morning. Plantar fasciitis is sharp, at the front inner edge of the heel, and worst on those first steps. You can have both.
NHS leaflets list weight, age, unsupportive shoes, long spells of standing, a sudden increase in activity, diabetes, inflammatory arthritis and long-term steroid tablets, and repeated steroid injections into the heel are another. The research behind these is thin.
From the pattern of pain and an examination: pressing the centre of the heel brings it on, and pulling the toes up doesn't. An ultrasound can measure the pad, but studies disagree on what thickness means, so a scan supports the diagnosis rather than decides it.
No trial has tested them for fat pad syndrome. They make sense, because holding the heel pad in place improves its shock absorption in laboratory studies, and in plantar fasciitis a silicone heel pad plus stretching helped more people than custom orthoses.
Cushioned shoes with a firm heel counter that holds the heel, and a gel heel cup or pad in every pair you stand in, including slippers. Avoid flip-flops, backless slippers and walking barefoot on hard floors.
It may give short-term relief. In the only study, of 19 people with no comparison group, low-Dye taping cut walking pain from 6.5 to 4.2 out of 10. NHS Lanarkshire suggests keeping each application on for no more than 3 to 4 days.
No exercise has been tested for it. NHS leaflets use calf stretches, heel raises, foot-muscle exercises and low-impact exercise such as cycling or swimming, and say to focus on strengthening if stretching makes it worse.
No exercise or insole has been shown to rebuild it. Fat grafting has been tested only under the ball of the foot, in one small trial, so it is experimental for the heel.
Most people start to improve within 3 months of following the advice, though full recovery can take several months. If it hasn't started to improve by then, see a podiatrist.
An NHS pathway doesn't use injections as a first or second treatment for heel pain, and repeated injections can thin the heel fat. Cushioning, pacing and strengthening come first.
Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.
