Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
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Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
What Is Heel Fat Pad Atrophy?
The heel fat pad is a specialized shock-absorbing structure under the calcaneus — it consists of fibrous septa filled with fat lobules that compress and expand with each step, absorbing ground reaction forces and protecting the heel bone. Fat pad atrophy is the loss of this cushioning tissue, resulting in a thin, hard heel that transmits impact directly to the calcaneus. The result is deep, diffuse heel pain that’s present throughout the entire step cycle — unlike plantar fasciitis, which causes sharp pain primarily with first steps and at heel strike. At Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan, Dr. Tom Biernacki, DPM diagnoses and manages heel fat pad atrophy. Call (810) 206-1402.
Causes of Heel Fat Pad Atrophy
The most common causes are: age-related involution — the fat pad thins progressively after age 50, particularly in active individuals; corticosteroid injections — repeated cortisone injections into the heel can cause iatrogenic fat necrosis and accelerate atrophy (this is why we limit heel injections and use the lowest effective dose); biomechanical overload from high-impact activities; a history of high-energy heel trauma; systemic conditions including rheumatoid arthritis, collagen disorders, and severe diabetes with peripheral vascular disease. In our clinic, elderly patients with a history of multiple cortisone injections for “plantar fasciitis” who present with progressively worsening diffuse heel pain — despite negative imaging for plantar fasciitis — are the most common fat pad atrophy presentation.
Diagnosis — Clinical vs. Imaging
Fat pad atrophy is primarily a clinical diagnosis: the heel visually appears thin with visible bony prominences; palpation reveals a firm, non-compressible heel pad (normally, the heel pad should compress 8–10mm under light pressure); pain is diffuse across the entire heel rather than at the anterior medial calcaneus (plantar fasciitis location); and weight-bearing makes the bony contour of the calcaneus visible through the thinned skin. Ultrasound quantifies fat pad thickness — normal is 15–20mm, atrophy is <8mm. MRI shows loss of fat signal and absence of plantar fascia pathology (important to distinguish from plantar fasciitis, which can coexist).
Conservative Treatment Options
Unlike plantar fasciitis, fat pad atrophy has no targeted treatment that regenerates lost tissue. Management is focused on padding and load redistribution: viscoelastic heel cups (the key intervention — silicone gel heel cups that mechanically replace the cushioning function of the atrophied fat pad); cushioned shoes with significant rearfoot EVA or memory foam cushioning; rocker-bottom modifications to reduce heel load during the stance phase; custom orthotics with deep heel cups and additional rearfoot cushioning; and activity modification to reduce repetitive impact loading. Absolutely avoid further cortisone injections — they worsen the atrophy.
Emerging Treatments — Fat Pad Augmentation
Fat pad augmentation using autologous fat grafting (harvesting fat from the abdomen or thigh and injecting into the heel fat pad) is an emerging surgical option for severe symptomatic fat pad atrophy that has failed all conservative measures. Early results are promising — studies report significant pain reduction and improved pad thickness at 1–2 year follow-up. The procedure is performed under local anesthesia and requires 2–4 weeks of protected weight-bearing post-operatively. This is still considered an evolving technique and is not widely available — we can discuss referral options for appropriate candidates.
Differentiating Fat Pad Atrophy from Plantar Fasciitis
This distinction is clinically important because the treatments differ significantly: plantar fasciitis responds to stretching, arch support, and cortisone (while fat pad atrophy is worsened by cortisone); plantar fasciitis typically improves after the first few minutes of walking (post-static dyskinesia), while fat pad atrophy pain increases throughout prolonged weight-bearing; plantar fasciitis has a classic location at the medial calcaneal tubercle, while fat pad atrophy pain is diffuse across the plantar heel; and plantar fasciitis is treated with arch support while fat pad atrophy requires heel cushioning. Both can coexist — ultrasound and clinical exam together identify the primary driver.
Treatment in Howell & Bloomfield Hills Michigan
Dr. Tom Biernacki, DPM provides comprehensive heel pain evaluation including in-office diagnostic ultrasound at Balance Foot & Ankle — serving Howell, Brighton, Bloomfield Hills, Troy, Auburn Hills, West Bloomfield, and all Southeast Michigan. If you have chronic heel pain that has not responded to typical plantar fasciitis treatment, fat pad atrophy may be the underlying issue. Book your evaluation online or call (810) 206-1402.
Dr. Tom’s Pick: Women’s Shoe Comfort Inserts
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Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
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Heel Fat Pad Atrophy Treatment in Michigan
Fat pad atrophy syndrome causes painful walking when the natural heel cushioning thins with age. Our podiatrists diagnose this underrecognized condition with ultrasound and provide specialized padding, orthotics, and advanced treatment options.
Learn About Our Heel Pain Treatments → | Book Your Appointment | Call (810) 206-1402
Clinical References
- Dalal S, et al. Plantar fat pad atrophy and its relationship to heel pain. Foot Ankle Int. 2015;36(2):150-156.
- Jahss MH, et al. Investigations into the fat pads of the sole of the foot. Foot Ankle. 1992;13(5):233-242.
- Özdemir H, et al. Quantitative evaluation of heel pad elasticity using ultrasonography. J Am Podiatr Med Assoc. 2004;94(1):47-52.
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Howell Office
3980 E Grand River Ave, Suite 140
Howell, MI 48843
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Bloomfield Hills Office
43700 Woodward Ave, Suite 207
Bloomfield Hills, MI 48302
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Same-week appointments available at both locations.
Book Your AppointmentMore Podiatrist-Recommended Foot Health Essentials
Hoka Clifton 10
Max-cushion everyday shoe — podiatrist favorite for walking and running.
PowerStep Pinnacle Insole
- The Pinnacle Full length insoles for men & women provide maximum cushioning, from high activity to moderate support. The PowerStep arch support shape provides stability to the foot and ankle, helping to relieve foot pain.
- When you spend all day on your feet, every step counts. PowerStep insoles are a podiatrist-recommended orthotic to help relieve & prevent foot pain related to athletes, runners, Plantar Fasciitis, heel spurs & other common foot, ankle & knee injuries
- The Pinnacle plantar fasciitis insoles offer superior heel cushioning and arch support. The dual-layer cushioning is designed to reduce stress and fatigue, while PowerStep premium arch support is designed for plantar fasciitis relief.
- The PowerStep Pinnacle arch support inserts for men & women can be worn in a variety of shoe types such as; athletic, walking, running, work & some casual shoes. Orthotic Inserts are ordered by shoe size, no trimming required.
- Made in the USA & backed by a 30-day money-back guarantee. PowerStep orthotic inserts for men & women are designed for shoes where the factory insole can be removed. HSA & FSA Eligible
The podiatrist-recommended over-the-counter orthotic.
OOFOS Recovery Slide
- The Original Recovery Footwear.
- Finding Your Size - For your perfect fit, consult the “size chart” link above. Wear a half size? In general, we recommend that women who wear a ½ size size UP, and men who wear a ½ size size DOWN
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- OOfoam Technology - Our revolutionary OOfoam technology absorbs 37% more impact than traditional footwear foams to reduce the stress on your feet, joints & back. Plus, the closed-cell foam is machine washable and designed to minimize odor
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Impact-absorbing recovery sandal — wear after long days on your feet.
As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. Product recommendations are based on clinical experience; prices and availability shown above update live from Amazon.
When to See a Podiatrist
If foot or ankle pain has been bothering you for more than a few weeks, home care alone may not be enough. Balance Foot & Ankle offers same-week appointments at our Howell and Bloomfield Hills clinics — no referral needed in most cases. Bring your current shoes and a short list of symptoms and we’ll build you a treatment plan in one visit.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
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Podiatrist-recommended products
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Replace lost cushioning with silicone cups.
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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
Frequently Asked Questions
Can I see a podiatrist for heel pain without a referral?
How long does plantar fasciitis take to heal?
Should I walk on my heel if it hurts?
What does a podiatrist do for heel pain?
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
Related Treatments at Balance Foot & Ankle
Our board-certified podiatrists offer advanced treatments at our Bloomfield Hills and Howell locations.