Pain in the heel is common and there are a number of causes of that. Plantar fasciitis is certainly the most common problem and is generally simple to diagnose. However, there are plenty of other causes that are not as frequent and are much harder to diagnose. Among the less common causes is a disorder 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. Usually there is plenty of fat there to provide that protection, however in some individuals it atrophies or wastes away and it can no longer guard the heel with that shock reduction. Precisely why it occurs isn't completely obvious, there is however some atrophy of that fat pad with ageing and some simply seem to atrophy a lot more than others quicker. The primary symptoms of fat pad atrophy are increasing pain with standing and walking under the heel. Additionally it is important to exclude other conditions because they could exist simultaneously.
The primary approach to deal with heel pad atrophy is to substitute the fat that has wasted away. The simplest way is to use pads in the footwear beneath the heel, usually made of a silicone gel which has a similar consistency as the natural fat, because they theoretically replace the pad that is missing. This typically works with just about all cases of this and that is all that has to be done. The only issue with this approach is that you need to wear the pads and you can’t do this when barefoot or in sandals without difficulty. The only other choice is a surgical procedure called augmentation in which some fat is surgically implanted beneath the heel. The injected fat can come from another part of the body or could be synthetically created in the laboratory. The longer term outcomes of this sort of method are not yet known, but early results from the surgery appear good.