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

BACKGROUND: 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. OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.