BACKGROUND
Heel fat pad syndrome (HFPS) is a common cause of plantar heel pain, typically characterized by macro-atrophy of the adipose tissue. However, some clinical cases present with severe pain despite preserved fat pad thickness. This report describes an underrecognized, stiffness-dominant HFPS presentation identified via layer-specific dynamic ultrasound, and details the short-term clinical course following targeted biomechanical taping.
CASE REPORT
A 50-year-old woman presented with chronic, refractory heel pain exacerbated during weight-bearing activities. While dynamic ultrasound revealed preserved macro-chamber thickness compared to the healthy side, it demonstrated significant internal stiffening. The sonographic compressibility index (CI) of the affected macro-chamber was markedly reduced to 25.17%, indicating a profound loss of functional compliance. To address this, a “gathering” functional taping technique was applied with the aim of engaging the windlass mechanism and mechanically decompressing the tissue. This intervention was associated with immediate, significant pain relief and a restoration of the CI to a normal range (33.00%). Following a supplementary 3-week exercise program focusing on ankle mobility, the patient achieved complete functional recovery (AOFAS score: 100).
CONCLUSIONS
This case report describes a proposed stiffness-dominant phenotype of HFPS identified in a single patient; its diagnostic relevance remains to be established in larger studies. Reduced functional compressibility can be clinically informative in selected presentations with preserved thickness. Layer-specific dynamic ultrasound can help identify this presentation, and targeted taping warrants consideration as a pragmatic intervention pending broader validation. These findings suggest that functional compressibility assessment can complement conventional thickness-based evaluation in treatment-refractory heel pain.

Keywords: Bandages; Biomechanical Phenomena; Heel; Pain; Ultrasonography