Ultrasonographic Detection of Age-Related Structural Degeneration in the Heel Fat Pad

Age-related changes in the heel fat pad (HFP) are not fully characterized beyond thickness measurements, despite their potential impact on foot biomechanics and function.

The aim of the study was to evaluate ultrasonographic structural changes in the HFP across different age groups and to determine whether qualitative ultrasonographic parameters provide a more sensitive assessment of age-related structural degeneration than thickness measurements alone.

A cross-sectional observational study was conducted, including 140 asymptomatic participants aged 18-89 years, stratified into three age groups (18-45, 46-65, and 66-89 years). Ultrasound assessment included measurements of thickness, echogenicity, echostructure, and Doppler flow. Statistical analyses were performed using one-way ANOVA, two-way ANOVA, and chi-square tests.

Significant age-related differences were observed in echostructure, echogenicity, and horizontal fibrous band (HFB) integrity (p < 0.0001), characterized by progressive disruption and loss of compartmental organization, predominantly affecting the deep subcutaneous macrochamber (DSM) and fibrous septa. These alterations followed a consistent age-related pattern across groups. In contrast, thickness measurements demonstrated smaller and less consistent differences. No relevant intralesional Doppler signal was detected.

Qualitative ultrasonographic abnormalities of the HFP, particularly involving echostructure, echogenicity, and HFB integrity, appear to detect age-related structural degeneration more consistently than thickness measurements alone. Incorporating qualitative ultrasound assessment may improve the evaluation of structural tissue remodeling in asymptomatic individuals.