Journal of Foot and Ankle Surgery (Asia Pacific)

Register      Login

VOLUME 10 , ISSUE 1 ( January-March, 2023 ) > List of Articles

REVIEW ARTICLE

Different Measurement Methods of Heel Pad Thickness and their Clinical Implications: A Narrative Review

Sanjay Kumar

Keywords : Complications, Diagnosis, Heel pad thickness, Magnetic resonance imaging, Ultrasonography

Citation Information : Kumar S. Different Measurement Methods of Heel Pad Thickness and their Clinical Implications: A Narrative Review. J Foot Ankle Surg Asia-Pacific 2023; 10 (1):224-228.

DOI: 10.5005/jp-journals-10040-1246

License: CC BY-NC 4.0

Published Online: 31-12-2022

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Introduction: The heel pad has an important role in pain-free locomotion due to its shock-attenuation function. Various diagnostic techniques are available to measure heel pad thickness. However, each measurement method makes a different clinical impact on heel pad thickness. Aim of the study: The current study will be aimed to evaluate the clinical impact of different measurement methods on heel pad thickness. Methodology: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines will be used for conducting this systematic review and meta-analysis. Literature searches will be carried out on the following databases, such as Cochrane, Google Scholar, PubMed, EMBASE, and Medline databases with the appropriate key terms. Relevant articles will be chosen for full-text screening after the application of the eligibility criteria. Meta-analysis will be performed using Review Manager 5.3 software. Observations and analysis: The current systematic review and meta-analysis will include all the published studies regarding the impact of different measurement methods on heel pad thickness. Finally, the review will summarize and analyze the results of the included studies to find out the most frequently used measurement methods and their clinical impact. Discussion: Increased heel pad thickness, commonly known as the heel pad sign, is characterized by an increase in the soft tissue thickness of the heel pad on lateral ankle radiographs in a variety of circumstances (Rogers et al., 2022; Morales-Orcajo et al., 2018). Studies on heel pad thickness using nonweight-bearing radiographs have indicated atrophy of the heel pad in elderly, sedentary subjects, while a recent study has demonstrated that ultrasonic heel pad thickness was significantly greater in patients suffering from unilateral displaced intra-articular fractures of the calcaneum at 21–35 months after injury (Lin et al., 2022; Taş, 2018). Conclusion: Different methods like photography, radiography, ultrasonography, and magnetic resonance imaging (MRI) have been used for the measurement of thickness of heel pad. However, ultrasonography and radiographic methods have found the maximum use in clinical applications for individuals with or without health issues. Hence, although the most widely used method is ultrasound due to its safety and efficacy, this is dependent on the requirement and availability of the choice of these methods which may vary.


HTML PDF Share
  1. Udoh BE, Archibong BE, Egong AE. Sonographic assessment of heel pad thickness in patients with poorly controlled diabetes. J Diagn Med Sonogr 2019;35(5):374–379. DOI: 10.1177/8756479319856283
  2. Negishi T, Ito K, Kamono A, et al. Strain-rate dependence of viscous properties of the plantar soft tissue identified by a spherical indentation test. J Mech Behav Biomed Mater 2020;102:103470. DOI: 10.1016/j.jmbbm.2019.103470
  3. Belhan O, Kaya M, Gurger M. The thickness of heel fat-pad in patients with plantar fasciitis. Acta Orthop Traumatol Turc 2019;53(6):463–467. DOI: 10.1016/j.aott.2019.07.005
  4. Uzel M, Cetinus E, Bilgic E, et al. Comparison of ultrasonography and radiography in assessment of the heel pad compressibility index of patients with plantar heel pain syndrome. Measurement of the fat pad in plantar heel pain syndrome. Joint Bone Spine 2006;73(2):196–199. DOI: 10.1016/j.jbspin.2005.05.008
  5. Rai V, Moellmer R, Agrawal DK. Clinically relevant experimental rodent models of diabetic foot ulcer. Mol Cell Biochem 2022;477(4):1239–1247. DOI: 10.1007/s11010-022-04372-w
  6. White S, Akangah P, McCullough M. The structural effects of diabetes on soft tissues: a systematic review. Crit Rev Biomed Eng 2021;49(6):11–27. DOI: 10.1615/CritRevBiomedEng.2022043200
  7. Maemichi T, Tsutsui T, Matsumoto M, et al. The relationship of heel fat pad thickness with age and physiques in Japanese. Clin Biomech 2020;80:105110. DOI: 10.1016/j.clinbiomech.2020.105110
  8. Freedman B, Mooney DJ. Biomaterials to mimic and heal connective tissues. Adv Mater 2019;31(19):1806695. DOI: 10.1002/adma.201806695
  9. Kuo AD, Donelan JM. Dynamic principles of gait and their clinical implications. Phys Ther 2010;90(2):157–174. DOI: 10.2522/ptj.20090125
  10. Shiotani H, Yamashita R, Mizokuchi T, et al. Site- and sex-differences in morphological and mechanical properties of the plantar fascia: a supersonic shear imaging study. J Biomech 2019;85:198–203. DOI: 10.1016/j.jbiomech.2019.01.014
  11. Steinbach HL, Russell W. Measurement of the heel-pad as an aid to diagnosis of acromegaly. Radiology 1964;82(3):418–423. DOI: 10.1148/82.3.418
  12. El-Nahas M, Gawish H, Tarshoby M, et al. The prevalence of risk factors for foot ulceration in Egyptian diabetic patients. Prim Care Diabetes 2008;25(9):362–366. DOI: 10.1002/pdi.1311
  13. Bolgla LA, Malone TR. Plantar fasciitis and the windlass mechanism: a biomechanical link to clinical practice. J Athl Train 2004;39(1):77–82.
  14. Rome K. Mechanical properties of the heel pad: current theory and review of the literature. Foot 1998;8(4):179–185. DOI: 10.1016/S0958-2592(98)90026-8
  15. Karr SD. Subcalcaneal heel pain. Orthop Clin North Am 1994;25(1):161–175. DOI: 10.1016/S0030-5898(20)31875-7
  16. Bencardino J, Rosenberg ZS, Delfaut E. MR imaging in sports injuries of the foot and ankle. Magn Reson Imaging Clin N Am 1999;7(1):131–149. DOI: 10.1016/S1064-9689(21)00504-3
  17. Draghi F, Ferrozzi G, Urciuoli L, et al. Hoffa’s fat pad abnormalities, knee pain and magnetic resonance imaging in daily practice. Insights Imaging 2016;7(3):373–383. DOI: 10.1007/s13244-016-0483-8
  18. Narváez JA, Narváez J, Ortega R, et al. Painful heel: MR imaging findings. Radiographics 2000;20(2):333–352. DOI: 10.1148/radiographics.20.2.g00mc09333
  19. El-Noueam KI, Giuliano V, Schweitzer ME, et al. Rheumatoid nodules: MR/pathological correlation. J Comput Assist Tomogr 1997;21(5):796–799. DOI: 10.1097/00004728-199709000-00027
  20. Sąsiadek MJ. Intracranial lesions with high signal intensity on T1-weighted MR images—review of pathologies. Pol J Radiol 2013;78(4):36–46. DOI: 10.12659/PJR.889663
  21. Rogers J, Jones G, Cook JL, et al. Calcaneal bone marrow lesions and plantar fascia imaging biomarkers are associated with chronic plantar heel pain: a case-control study. Arthritis Care Res (Hoboken) 2022. DOI: 10.1002/acr.24887
  22. Lin CY, Chen PY, Wu SH, et al. Biomechanical effects of plastic heel cup on plantar fasciitis patients evaluated by ultrasound shear wave elastography. J Clin Med 2022;11(8):2150. DOI: 10.3390/jcm11082150
  23. Wagner DR. Ultrasound as a tool to assess body fat. J Obes 2013;2013:280713. DOI: 10.1155/2013/280713
  24. Morales-Orcajo E, de Bengoa Vallejo RB, Losa Iglesias M, et al. Foot internal stress distribution during impact in barefoot running as function of the strike pattern. Comput Methods Biomech Biomed Eng 2018;21(7):471–478. DOI: 10.1080/10255842.2018.1480760
  25. Taş S. Effect of gender on mechanical properties of the plantar fascia and heel fat pad. Foot Ankle Spec 2018;11(5):403–409. DOI: 10.1177/1938640017735891
  26. Duffin AC, Lam A, Kidd R, et al. Ultrasonography of plantar soft tissues thickness in young people with diabetes. Diabetic Med 2002;19(12):1009–1013. DOI: 10.1046/j.1464-5491.2002.00850.x
  27. Junyent M, Gilabert R, Zambon D, et al. The use of Achilles tendon sonography to distinguish familial hypercholesterolemia from other genetic dyslipidemias. Arterioscler Thromb Vasc Biol 2005;25(10):2203–2208. DOI: 10.1161/01.ATV.0000183888.48105.d1
  28. Jeffcoate SL. Diabetes control and complications: the role of glycated haemoglobin, 25 years on. Diabet Med 2004;21(7):657–665. DOI: 10.1046/j.1464-5491.2003.01065.x
  29. Makita Z, Radoff S, Rayfield EJ, et al. Advanced glycosylation end products in patients with diabetic nephropathy. N Engl J Med 1991;325(12):836–842. DOI: 10.1056/NEJM199109193251202
  30. Benard MA, Stephens DG. A racial comparison of morphology in the lower extremity: a preliminary study. J Am Podiatry Assoc 1979;69(5):287–295. DOI: 10.7547/87507315-69-5-287
  31. Kho KM, Wright AD, Doyle FH. Heel pad thickness in acromegaly. Br J Radiol 1970;43(506):119–125. DOI: 10.1259/0007-1285-43-506-119
  32. Jackson DM. Heel-pad thickness in obese persons. Radiology 1968;90(1):129. DOI: 10.1148/90.1.129
  33. Taş S, Bek N, Ruhi Onur M, et al. Effects of body mass index on mechanical properties of the plantar fascia and heel pad in asymptomatic participants. Foot Ankle Int 2017;38(7):779–784. DOI: 10.1177/1071100717702463
  34. Tahririan MA, Motififard M, Tahmasebi MN et al. Plantar fasciitis. J Res Med Sci 2012;17(8):799–804.
  35. Irving DB, Cook JL, Menz HB. Factors associated with chronic plantar heel pain: a systematic review. J Sci Med Sport 2006;9(1–2):11–22. DOI: 10.1016/j.jsams.2006.02.004
  36. Roemer FW, Jarraya M, Felson DT, et al. Magnetic resonance imaging of Hoffa’s fat pad and relevance for osteoarthritis research: a narrative review. Osteoarthritis Cartilage 2016;24(3):383–397. DOI: 10.1016/j.joca.2015.09.018
  37. Hunter DJ, Lo GH, Gale D, et al. The reliability of a new scoring system for knee osteoarthritis MRI and the validity of bone marrow lesion assessment: BLOKS (Boston Leeds Osteoarthritis Knee Score). Ann Rheum Dis 2008;67(2):206–211. DOI: 10.1136/ard.2006.066183
  38. Udoh B, Ezeokpo B, Ulu O, et al. Sonographic assessment of the heel pad thickness in normal Nigerians. World J Med Sci 2010;5(4):85–88.
  39. Greene E. Plantar fasciitis and the plantar heel fat pad. Aust Podiatr Assoc 1995;12:89–93.
  40. Kerr PS, Silver DA, Telford K, et al. Heel-pad compressibility after calcaneal fractures: ultrasound assessment. J Bone Joint Surg Br 1995;77(3):504–505.
  41. Prichasuk S. The heel pad in plantar heel pain. J Bone Joint Surg Br 1994;76(1):140–142.
  42. Levy AS, Berkowitz R, Franklin P, et al. Magnetic resonance imaging evaluation of calcaneal fat pads in patients with os calcis fractures. Foot Ankle 1992;13(2):57–62. DOI: 10.1177/107110079201300202
  43. Gooding GA, Stress RM, Graf PM, et al. Heel pad thickness: determination by high-resolution ultrasonography. J Ultrasound Med 1985;4(4):173–174. DOI: 10.7863/jum.1985.4.4.173
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.