Heel pain is common and there are a number of causes of this. Plantar fasciitis is by far the most common condition and is usually simple to diagnose. However, there are numerous other reasons that are not as frequent and are more complicated to diagnose. One of the less frequent causes is a problem referred to as heel fat pad atrophy. There is a covering of fat beneath the heel which provides a cushion and shock absorber while we are walking or running. Usually there is enough fat there to provide that cushioning, but in some individuals it atrophies or wastes away and it may no longer guard the heel with that shock reduction. Exactly why it occurs is not entirely clear, there is however some atrophy of that fat pad with aging and some just seem to atrophy a lot more than others at a faster rate. The key signs of fat pad atrophy are increasing pain with weight bearing under the heel. It is also crucial that you eliminate other reasons since they may exist simultaneously.
The main 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 under the heel, preferably made from a silicone gel that has a similar consistency as the natural fat, since they theoretically substitute the pad which is atrophied. This commonly works with nearly all cases of this and that is all that has 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 choice is a surgical procedure called augmentation where some fat is surgically inserted under the heel. The inserted fat may come from another part of the body or might be artificially made in the laboratory. The long term results of this type of approach aren't yet known, but early results from the procedure appear excellent.
