• 1

    Pfeffer GB, Baxter DE: “Surgery of the Adult Heel,” in Disorders of the Foot and Ankle, 2nd Ed, Vol 2, ed by EH Wickland, p 1396, WB Saunders, Philadelphia, 1992..

    • PubMed
    • Export Citation
  • 2

    Wolgin M, Cook C, Graham C, et al: Conservative treatment of plantar heel pain: long-term follow-up. .Foot Ankle 15::97. ,1994. .

  • 3

    Schepsis AA, Leach RE, Gorzyca J: Plantar fasciitis: etiology, treatment, surgical results and review of the literature. .Clin Orthop 266::185. ,1991. .

  • 4

    Warren BL: Plantar fasciitis in runners: treatment and prevention. .Sports Med 10::338. ,1990. .

  • 5

    Daly PJ, Kitaoka HB, Chao EY: Plantar fasciotomy for intractable plantar fasciitis: clinical results and biomechanical evaluation. .Foot Ankle 13::188. ,1992. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Mann RA: Surgery of the Foot, 5th Ed, p 244, CV Mosby, St Louis, 1986..

  • 7

    Anderson RB, Foster MD: Operative treatment of subcalcaneal heel pain. .Foot Ankle 9::317. ,1989. .

  • 8

    McCarthy D, Gorecki G: The anatomical basis of inferior calcaneal lesions: a cryomicrotomy study. .JAPA 69::527. ,1979. .

  • 9

    Rubin G, Witten M: Plantar calcaneal spurs. .Am J Orthop 5::38. ,1963. .

  • 10

    Rosenfeld S: Management of the heel spur (syndrome). .JAPMA 75::315. ,1985. .

  • 11

    Baxter DE, Thigpen CE: Heel pain: operative results. .Foot Ankle 5::16. ,1984. .

  • 12

    Tanz SS: Heel pain. .Clin Orthop 28::169. ,1963. .

  • 13

    Kenzora JE: The painful heel syndrome: an entrapment neuropathy. .Bull Hosp Jt Dis Orthop Inst 47::178. ,1987. .

  • 14

    Lutter LD: Surgical decisions in athletes’ subcalcaneal pain. .Am J Sports Med 14::481. ,1986. .

  • 15

    Snook GA, Chrisman OD: The management of subcalcaneal pain. .Clin Orthop 82::163. ,1972. .

  • 16

    Miller WE: The heel pad. .Am J Sports Med 10::19. ,1982. .

  • 17

    Jorgensen U: Achillodynia and loss of heel pad shock absorbency. .Am J Sports Med 13::128. ,1985. .

  • 18

    Prichasuk S, Mulpruek P, Siriwongpairat P: The heel-pad compressibility. .Clin Orthop 300::197. ,1994. .

  • 19

    Prichasuk S: The heel pad in plantar heel pain. .J Bone Joint Surg Br 76::140. ,1994. .

  • 20

    Turgut A, Göktürk E, Köse N, et al: The relationship of heel pad elasticity and plantar heel pain. .Clin Orthop 360::191. ,1999. .

  • 21

    Graham CE: Painful heel syndrome: rationale of diagnosis and treatment. .Foot Ankle 3::261. ,1983. .

  • 22

    Protzman RR, Griffs CG: Stress fracture in men and women undergoing military training. .J Bone Joint Surg Am 59::825. ,1977. .

  • 23

    Quigley JT: A glomus tumour of the heel pad. .J Bone Joint Surg Am 61::443. ,1979. .

  • 24

    Lin E, Ronen M, Stampler D, et al: Painful piezogenic heel papules. .J Bone Joint Surg Am 67::640. ,1985. .

  • 25

    Berlin SJ, Mirkin GS, Tubridy SP: Tumors of the heel. .Clin Podiatr Med Surg 7::307. ,1990. .

  • 26

    Satku K, Pho RW, Wee A: Painful heel syndrome—an unusual cause: case report. .J Bone Joint Surg Am 66:: 607. ,1984. .

  • 27

    Smith RW, Smith CF: Solitary unicameral bone cyst of the calcaneus: a review of twenty cases. .J Bone Joint Surg Am 56::49. ,1974. .

  • 28

    Bordelon RL: “Heel Pain,” in Surgery of the Foot and Ankle, 6th Ed, ed by RA Mann, p 837, CV Mosby, St Louis, 1993..

    • PubMed
    • Export Citation
  • 29

    Karr SD: Subcalcaneal heel pain. .Orthop Clin North Am 25::161. ,1994. .

  • 30

    McKenzie DC, Clement DB, Taunton JE: Running shoes, orthotics and injuries. .Sports Med 2::334. ,1985. .

  • 31

    Clain MR, Baxter DE: Achilles tendinitis. .Foot Ankle 13::482. ,1992. .

  • 32

    Keck SW, Kelly PJ: Bursitis of the posterior part of the heel. .J Bone Joint Surg Am 47::267. ,1983. .

  • 33

    Scioli MW: Achilles tendinitis. .Orthop Clin North Am 25::177. ,1994. .

  • 34

    Clement DB, Founton JE, Smart GW: Achilles tendinitis and peritendinitis: etiology and treatment. .Am J Sports Med 12::179. ,1984. .

  • 35

    Gerster JC: Plantar fasciitis and Achilles tendinitis among 150 cases of seronegative spondarthritis. .Rheumatol Rehabil 19::218. ,1980. .

  • 36

    Gerster JC, Vischer T, Bennani A, et al: The painful heel: comparative study in rheumatoid arthritis, ankylosing spondylitis, Reiter’s syndrome, and generalized osteoarthritis. .Ann Rheum Dis 36::343. ,1977. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Shaw RA, Holt PA, Stevens MB: Heel pain in sarcoidosis. .Ann Intern Med 109::675. ,1988. .

  • 38

    Lichniak JE: The heel in systemic disease. .Clin Podiatr Med Surg 7::225. ,1990. .

  • 39

    Jahss MH, Kummer F, Michelson JD: Investigations into the fat pads of the sole of the foot: heel pressure studies. .Foot Ankle 13::227. ,1992. .

  • 40

    Paul IL, Munro MB, Abernathy PJ, et al: Musculoskeletal shock absorption: relative contribution of bone and soft tissues at various frequencies. .J Biomech 11::237. ,1978. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41

    Perry J: Anatomy and biomechanics of the hindfoot. .Clin Orthop 177::9. ,1983. .

  • 42

    Jahss MH, Michelson JD, Desai P, et al: Investigations into the fat pads of the sole of the foot: anatomy and histology. .Foot Ankle 13::233. ,1992. .

  • 43

    Bray GA, Jordan HA, Sims EAH: Evaluation of the obese patient: 1. An algorithm. .JAMA 235::1487. ,1976. .

  • 44

    Brotzman SB, Brosel J: “Foot and Ankle Rehabilitation,” in Clinical Orthopaedics Rehabilitation, ed by SB Brotzman, p 245, CV Mosby, St Louis, 1996..

    • PubMed
    • Export Citation
  • 45

    Jorgensen U, Bojsen-Moller F: Shock absorbency of factors in the shoe/heel interaction with special focus on role of the heel pad. .Foot Ankle 9::294. ,1989. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46

    Davis PF, Severud MD, Baxter DE: Painful heel syndrome: results of nonoperative treatment. .Foot Ankle 15::521. ,1994. .

  • 47

    Hill JJ, Cutting PJ: Heel pain and body weight. .Foot Ankle 9::254. ,1989. .

  • 48

    Hsu TC, Wang CL, Tsai WC, et al: Comparison of the mechanical properties of the heel pad between young and elderly adults. .Arch Phys Med Rehabil 79::1101. ,1998. .

    • PubMed
    • Search Google Scholar
    • Export Citation

Effects of Changes in Heel Fat Pad Thickness and Elasticity on Heel Pain

Hakan Özdemır Department of Orthopaedics and Traumatology, Medical School of Akdeniz University, Antalya, Turkey.

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Yetkın Söyüncü Department of Orthopaedics and Traumatology, Medical School of Akdeniz University, Antalya, Turkey.

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Mete Özgörgen Department of Orthopaedics and Traumatology, Medical School of Akdeniz University, Antalya, Turkey.

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Kürşat Dabak Department of Orthopaedics and Traumatology, Medical School of Akdeniz University, Antalya, Turkey.

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The heel fat pad has a unique structure that is important for its shock-absorbing function. Loss of elasticity and changes in the thickness of the heel pad have been suggested as causes of heel pain. The present study of a population with heel pain shows the relationship between the thickness and elasticity of the heel fat pad and age, sex, obesity, duration of symptoms, subcalcaneal spurs, and noninvasive conservative treatment. Of 182 patients with heel pain who visited an outpatient clinic during a 3-year period, 50 (67 heels) fulfilling specific criteria were treated with a combination of nonsteroidal anti-inflammatory drugs, contrast baths, stretching exercises, and change of footwear habits. Patients were followed up for 1 year. Delayed healing, increased thickness, and decreased elasticity of the heel fat pad were found in patients who were older than 40 years, who had symptoms for longer than 12 months before treatment, and who had a large subcalcaneal spur. An increase in heel fat pad thickness with aging and increased body weight reduce the elasticity of the heel fat pad. In addition, subcalcaneal spurs diminish the elasticity of the heel fat pad and play a role in the formation of heel pain. (J Am Podiatr Med Assoc 94(1): 47-52, 2004)

Corresponding author: Hakan Özdemır, MD, Akdeniz Üniversitesi Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, Antalya 07070, Turkey.
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