Heel pain is common and there are a number of causes of this. Plantar fasciitis is by far the most frequent problem and is often easy to diagnose. However, there are numerous other causes that aren't as common and are much harder to diagnose. Among the less common causes is a condition referred to as heel fat pad atrophy. There is a layer of fat underneath the heel which provides a cushion and shock absorber while we are running or walking. Ordinarily there is enough fat there to provide that cushioning, however in some individuals it atrophies or wastes away and it may no longer guard the heel with that shock reduction. Exactly why it happens is not entirely obvious, but there is some atrophy of that fat pad with growing older and some just appear to atrophy a lot more than others quicker. The key signs of this problem are usually increasing pain with weight bearing beneath the heel. It is also crucial that you rule out other reasons as they might exist at the same time.
The main approach to deal with heel pad atrophy is to replace the fat that has wasted away. The easiest way is to wear pads in the shoe underneath the heel, ideally made from a silicone gel which has a similar consistency as the natural fat, as they technically replace the pad that is atrophied. This generally deals with just about all cases of this and this is all that needs to be done. A possible problem with this method is that you have to use the pads and you can’t do this when barefoot or in sandals without difficulty. The only other choice is surgery called augmentation where some fat is surgically inserted underneath the heel. The inserted fat can come from another area of the body or may be artificially created in the laboratory. The long term outcomes of this sort of method are not yet known, however early results from the surgery appear good.