Heel pain is common and there are a number of reasons for that. Plantar fasciitis is by far the most frequent problem and is generally easy to diagnose. However, there are many other causes that are not as common and are much harder to diagnose. Among the less frequent conditions is a ailment known as heel fat pad atrophy. There is a covering of fat beneath the heel which provides a cushion and shock absorber while we are running or walking. Usually there's sufficient fat there to provide that protection, but in some individuals it atrophies or wastes away and it can no longer guard the heel with that cushioning. The reason why it happens is not completely clear, there is however some atrophy of that fat pad with aging and some just appear to atrophy more than others quicker. The key signs of this problem are usually increasing pain with standing and walking under the heel. It is also important to eliminate other causes because they might exist simultaneously.

The main approach to manage heel pad atrophy is to substitute the fat that has wasted away. The easiest way is to use pads in the shoe beneath the heel, preferably made from a silicone gel that has the same consistency as the natural fat, as they technically replace the pad that is atrophied. This typically works with nearly all cases of this and that is all that needs to be done. The only problem with this method is you need to wear 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 beneath the heel. The injected fat may come from another part of the body or may be artificially made in the laboratory. The long term results of this type of approach for heel pad atrophy are not yet known, but early results from the procedure appear excellent.