Heel pain is common and there are many different causes of that. Plantar fasciitis is by far the most common problem and is often easy to diagnose. However, there are plenty of other causes that are not as common and are harder to diagnose. One of the less common causes is a condition known as heel fat pad atrophy. There is a layer of fat under the heel that acts as a cushion and shock absorber when we are walking or running. Normally there is enough fat there to provide that protection, but in some people it atrophies or wastes away and it can no longer protect the heel with that cushioning. The reason why it happens is not entirely clear, but there is some atrophy of that fat pad with aging and some just seem to atrophy more than others at a faster rate. The main symptoms of this problem are increasing pain with weight bearing under the heel. It is also important to rule out other causes as they may exist at the same time.
The main way to treat heel pad atrophy is to replace the fat that has wasted away. The easiest way is to wear pads in the shoe under the heel, preferably made of a silicone gel that has the same consistency as the natural fat, as they technically replace the pad that is missing. This typically deals with almost all cases of this and this is all that needs to be done. The only problem with this approach is that you have to wear the pads and you can’t do that when barefoot or in sandals very easily. The only other option is a surgical procedure called augmentation in which some fat is surgically implanted under the heel. The injected fat may come from another part of the body or may be artificially created in the laboratory. The long term results of this type of approach are not yet known, but early results from the procedure appear good.