Pain in the heel is common and there are many different causes of this. Plantar fasciitis is certainly the most frequent condition and is often simple to diagnose. However, there are many other reasons that are not as frequent and are harder to diagnose. Among the less common conditions is a condition known 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's sufficient fat there to provide that shock absorption, but in some people it atrophies or wastes away and it may no longer guard the heel with that shock reduction. Exactly why it happens isn't completely obvious, but there is some atrophy of that fat pad with getting older and some simply seem to atrophy greater than others at a faster rate. The key symptoms of this problem are usually increasing pain with weight bearing beneath the heel. Additionally it is essential to rule out other conditions as they might exist concurrently.
The primary strategy to deal with heel pad atrophy is to substitute the fat that has wasted away. The simplest way is to wear pads in the footwear beneath the heel, usually made of a silicone gel that has the same consistency as the natural fat, as they theoretically substitute the pad that is missing. This typically deals with almost all cases of this and that is all that has to be done. The only issue with this approach is you have to use 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 under the heel. The injected fat can come from another area of the body or could be synthetically created in the laboratory. The longer term outcomes of this sort of approach are not yet known, however early results from the surgery appear good.