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Musculoskeletal and Sports Medicine

A Rare Risk Comes True Following Corticosteroid Injection of Plantar Fascia: A Case Report of Calcaneal Fat Pad Atrophy

Saturday, October 25, 2025
8:00 AM - 9:15 AM MT
Location: Kiosk 3

    Co-Author(s)

  • KC

    Kyle Coffey, DO

    Resident
    University of Florida College of Medicine PM&R Program
    Gainesville, Florida

  • Daniel Kiehl, DO

    Resident Physician
    University of Florida College of Medicine PM&R Program
    Gainesville, Florida

    • Poster Presenter(s)

  • Jonah Maggard, BS

    Medical Student
    University of Florida College of Medicine
    Gainesville, Florida

    • Co-Author(s)

  • Antony Merendino, Other

    Clinical assistant professor
    University of Forida
    Gainesville, Florida

  • Jason Zaremski, MD

    Clinical Professor of PM&R and Sports Medicine
    University of Florida
    Gainesville, Florida

Disclosure(s):
Kyle Coffey, DO: No financial relationships to disclose
Daniel Kiehl, DO: No financial relationships to disclose
Jonah Maggard, BS: No financial relationships to disclose
Antony Merendino, Other: No financial relationships to disclose
Jason Zaremski, MD: No financial relationships to disclose
Case Diagnosis: Calcaneal fat pad atrophy 2/2 single corticosteroid injection of plantar fascia

Case Description or Program Description: The patient developed acute right heel pain following participation in a game of flag football. The patient denied any inciting event but noted pain that developed after the game that did not self-resolve. She was diagnosed with plantar fasciitis approximately 8 months later at an outside clinic and given a corticosteroid injection (CSI) in the right plantar fascia. The patient presented to our clinic approximately 3 months following the CSI with gradually worsening pain following the injection as well as a sensation of “less cushioning” on her right heel. A hindfoot MRI revealed mild edema at the plantar aspect of the calcaneal tuberosity without discrete fracture. She was placed in a walking boot for two weeks, then transitioned to a heel cup in shoes with instructions to alternate lidocaine patches and diclofenac gel for symptom relief.

Setting: Outpatient sports medicine clinic

Assessment/Results: The patient was diagnosed with calcaneal fat pad atrophy (FPA). She was instructed to continue using a heel cup and transition to rigid arch support. She was discouraged from walking barefoot or running on treadmills and given a home exercise program to strengthen intrinsic foot muscles. Plastic surgery was consulted to evaluate for possible synthetic filler injection as well as fat grafting of patient’s own adipose tissue from other areas of the body.

Discussion (relevance): While not commonly seen, calcaneal FPA was observed to occur after a single CSI of the plantar fascia which likely spread to the calcaneal fat pad, resulting in calcaneal FPA with associated pain and discomfort. Fat pad “filler” injections and fat grafting are potential treatment modalities that can restore comfort and reduce pain in some cases.

Conclusions: Benefits of plantar fascia corticosteroid injections should be carefully weighed against risks.