Subluxing fractured plantar heel fat pad (Plantar fat pad syndrome)

NewsBot · Nov 22, 2020

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Subluxing fractured plantar fat pad: a case series and description of novel sonographic findings
Walter I Sussman et al
Skeletal Radiol. 2020 Nov 2

Plantar fat pad syndrome has received little attention in the literature. A variety of structural changes of the plantar fat pad have been described in the literature, including atrophy, contusion, and fractured fat pad. This case series presents 4 patients (5 heels) with subluxation of a fractured plantar fat pad on dynamic ultrasound. Patients with subluxing fractured fat pad typically present with heel pain and a "snapping" or "popping" sensation when weight-bearing. Other causes of heel pain were excluded, and all patients in this series had an MRI that initially did not report any findings in the fat pad. Retrospective review of the MRI showed evidence of diffuse low T1 and T2 infiltration. To the authors' knowledge, subluxation of the plantar fat pad and the respective correlation to MRI findings have not been described in the literature. Here we describe the sonographic findings of this novel condition
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NewsBot · Nov 22, 2020

Related Thread:
Plantar fat pad properties

NewsBot · May 31, 2021

Heel fat pad syndrome beyond acute plantar fascitis
RamonBalius et al
The Foot; 25 May 2021, 101829

Highlights
•Heel pain is a frequent cause of pain and disability in adult active population.
•Pathological findings of the heel fat pad area using MRI and US can provide a differential diagnosis of heel pain beyond plantar fasciitis.
•Observational case series study of patients with fat pad atrophy in the plantar aspect of the heel with a bed-side exam with US.
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Heel pain is a frequent cause of pain and disability in adult active population. In patients with this clinical presentation, several causes must be ruled out, among them plantar fasciitis the most common. Other etiologies of plantar heel pain are the entrapment of muscular branch of the lateral plantar nerve (Baxter nerve) or fat pad atrophy, being the last one the second cause of heel pain after plantar fasciitis.

We describe a case series of patients with pathological findings of the heel fat pad area using MRI and US to provide a differential diagnosis of heel pain.

Observational case series study. Nine patients visited presented with pain in the plantar aspect of the heel.

The plantar aspect of the heel was evaluated in detail with US and MRI. Main inclusion criteria were to present acute or chronic pain on the plantar aspect.

In five cases the right heel was affected, in three cases the left heel. One case presented bilateral complaints. All patients presented mechanical pain. Specifically, four of them also described a constant clunk during footstep. Heel fat pad lesion was confirmed with MRI and US in the medial aspect, observed in five patients. In four patients, the heel fat pad was globally affected respectively.

This case series tries to put some light on other heel conflicts beside plantar fasciitis that should be ruled out, being one of those, heel fat pad atrophy. Our presentation highlight the role that bed side ultrasound can play in the definition of a specific pattern confirmed with MRI after the US.
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NewsBot · May 30, 2022

Platelet-rich plasma as a therapeutic option in heel fat pad syndrome
M García Garrido et al
Rehabilitacion (Madr). 2022 May 24

Heel fat pad syndrome is the second most frequent cause of heel pain at Rehabilitation services. It is a structure damage of the plantar fat that leads to loss of cushioning in gait and plantar pain. It is due to degeneration or repeated trauma that causes alteration of the structure of the foot pad losing its compressibility and function. The diagnosis of heel fat pad syndrome is made by ultrasound study. Treatment is primarily based on conservative measures. Infiltration with platelet-rich plasma is proposed as a therapeutic option with the aim of improving pain and inflammation of the plantar fat pad. We report the first published case of ultrasound-guided infiltration with platelet-rich plasma as a treatment for heel fat pad syndrome.
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NewsBot · Aug 18, 2022

What do we actually know about a common cause of plantar heel pain? A scoping review of heel fat pad syndrome
Alison H. Chang, Steven Zartov Rasmussen, Asger Emil Jensen, Thomas Sørensen & Michael Skovdal Rathleff
Journal of Foot and Ankle Research volume 15, Article number: 60 (2022)

Background
The heel fat pad is an important structure of the foot as it functions as a cushion to absorb shock and distribute plantar force during ambulation. Clinical practice guidelines or decision support platforms emphasize that heel fat pad syndrome (HFPS) is a distinct pathology contributing to plantar heel pain. We aimed to identify and synthesize the prevalence, etiology and diagnostic criteria, and conservative management of HFPS.

Methods
A comprehensive search was conducted in May 2021 and updated in April 2022, using MEDLINE, Scopus, Cinahl, EMBASE, Cochrane Library, SPORTDiscus, and PEDro and ClinicalTrials.gov and the World Health Organization's International Clinical Trials Registry Platform (ICTRP) for pertinent registrations. We included all study types and designs describing the prevalence; etiology and diagnostic criteria; and non-pharmacological, non-surgical interventions for HFPS.

Results
We found a small body of original research for HFPS (n = 7). Many excluded full-text articles were expert-opinion articles or studies of heel fat pad in participants with plantar fasciitis/fasciopathy or unspecified heel pain. HFPS may be the second leading cause of plantar heel pain, based on two studies. A number of differentiating pain characteristics and behaviors may aid in diagnosing HFPS vs. plantar fasciopathy. Thinning heel fat pad confirmed by ultrasonography may provide imaging corroboration. Randomized controlled trials assessing the efficacy of viscoelastic heel cups or arch taping for managing HFPS do not exist.

Conclusions
The research literature for HFPS is sparse and sometimes lacking scientific rigor. We have identified a substantial knowledge gap for this condition, frequent inattention to distinguishing HFPS from plantar fasciopathy when describing plantar heel pain, and an absence of robust clinical trials to support the commonly recommended conservative management of HFPS.
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