Pain in the heel frequently occurs and there are a number of causes of this. Plantar fasciitis is certainly the most common problem and is usually simple to diagnose. However, there are many other reasons that are not as common and are harder to diagnose. One of the less frequent causes is a disorder referred to as heel fat pad atrophy. There is a layer of fat underneath the heel which acts as a cushion and shock absorber when we are walking or running. Normally there is sufficient fat there to provide that shock absorption, but in some people it atrophies or wastes away and it can no longer guard the heel with that shock reduction. Exactly why it happens isn't entirely obvious, there is however some atrophy of that fat pad with getting older and some simply appear to atrophy greater than others quicker. The primary signs of fat pad atrophy are increasing pain with standing and walking under the heel. It is also essential to exclude other reasons as they may exist simultaneously.
The main way to take care of heel pad atrophy is to substitute the fat that has wasted away. The easiest way is to use pads in the shoe under the heel, ideally made of a silicone gel that has a similar consistency as the natural fat, as they theoretically replace the pad that is wasted. This ordinarily works with nearly all cases of this and that is all that has to be done. The only problem with this approach is you have to wear the pads and you can’t do this when without shoes or in sandals without difficulty. The only other option is a surgical procedure called augmentation where some fat is surgically inserted underneath the heel. The injected fat may come from another area of the body or may be synthetically created in the laboratory. The longer term results of this type of surgery are not yet known, but early results from the procedure appear good.