The infracalcaneal bursa, when identifiable as a distinct structure, lies in the heel fat pad between the calcaneal tuberosity and the plantar skin. The heel fat pad itself acts as a specialised shock absorber with a honeycomb micro-architecture. Fat pad atrophy from age, steroid injections, or plantar fascia overload produces heel pain that is distinct from plantar fasciitis.
Cushions the calcaneal plantar surface against ground impact forces
Heel fat pad syndrome produces diffuse plantar heel pain on weight bearing that is worse on hard surfaces — distinct from plantar fasciitis which is worst with first steps after rest. MRI shows fat pad thinning. Management focuses on heel cushioning (silicone cups, extra-depth footwear) and avoiding further fat pad atrophy from steroid injections which cause local fat necrosis.
Infracalcaneal cushioning failure from fat pad atrophy producing diffuse heel pain managed with silicone heel cups and footwear modification.
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