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Hello, I wonder if anyone can help. I have a 67 years old gentleman who is suffering with what it seems like fat pad irritation (both heels). He recently had to start wearing safety steel toe cap boots at work and since then the problems began.

The pain is described as "bruised and burning" it does improve significantly on the days he is off (4 at a time). Worse as the day goes on after he is on his feet for hours. during examination, the plantar fascia did not seem to be bothering him.
He has bilateral pes planus

I have given him silicone heel pads which it makes it more comfortable, however there is still pain. I also issued him with a pair of orthoses with varus control but he finds them difficult to wear as they press into the heel and hurt.
I 've asked to ice the area, which he forgot to do, and he can not take anti inflamatories.

Is there anything else I could be doing that I am missing? Obviously I have recommended to rest, and change the footwear, but this is not possible.

I look forward to any reply.

Rosa