Subluxing fractured plantar fat pad: a case series and description of novel sonographic findings
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CASE REPORT
Subluxing fractured plantar fat pad: a case series and description of novel sonographic findings Walter I. Sussman 1,2 & David J. Park 3 & Paul M. Rucci 2 & Yung H. Chen 4 Received: 28 July 2020 / Revised: 28 September 2020 / Accepted: 30 September 2020 # ISS 2020
Abstract Plantar fat pad syndrome has received little attention in the literature. A variety of structural changes of the plantar fat pad have been described in the literature, including atrophy, contusion, and fractured fat pad. This case series presents 4 patients (5 heels) with subluxation of a fractured plantar fat pad on dynamic ultrasound. Patients with subluxing fractured fat pad typically present with heel pain and a “snapping” or “popping” sensation when weight-bearing. Other causes of heel pain were excluded, and all patients in this series had an MRI that initially did not report any findings in the fat pad. Retrospective review of the MRI showed evidence of diffuse low T1 and T2 infiltration. To the authors’ knowledge, subluxation of the plantar fat pad and the respective correlation to MRI findings have not been described in the literature. Here we describe the sonographic findings of this novel condition. Keywords Heel pain . Subluxing fat pad . Fractured fat pad . Plantar fasciitis . Fat pad atrophy
Introduction The plantar fat pad, or heel pad, is a fibroadipose structure located beneath the calcaneus. Dense strands of fibrous septa form U-shaped compartments, which retain closely packed fat cells [1]. The septa are tethered to the calcaneus and dermis and reinforced internally by transverse and diagonal elastic fibers [2, 3]. The integrity of the fat pad is dependent on the septa that enclose each independent column of fat. When the heel is loaded, these septa are designed to resist compressive loads by restricting the movement and outflow of fat, allowing Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00256-020-03639-x) contains supplementary material, which is available to authorized users. * Walter I. Sussman [email protected] 1
Department of Physical Medicine & Rehabilitation, Tufts University School of Medicine, 800 Washington St, Box 400, Boston, MA 02111, USA
2
Private Practice N, Easton, MA, USA
3
Physical Medicine & Rehabilitation Resident, Tufts Medical Center, Boston, MA, USA
4
Department of Radiology, Tufts University, Boston, MA, USA
the fat pad to act as a shock absorber (Supplemental video 1: Normal plantar fat pad dynamic ultrasound evaluation) [4, 5]. The mechanical properties of the plantar fat pad change with age. Elderly individuals exhibit thicker and stiffer heel pads than younger patients [6–8], which has been attributed to a gradual loss of collagen, decrease in elastic fibrous tissue, and decrease in water content of the fat pad as the tissue ages [9]. In addition to age-related changes, damage to the plantar fat pad can occur from an acute injury or repetitive trauma. Injury can lead to atrophy of the fat pad with high or repetitive str
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