Heel pain is common and there are many different reasons for this. Plantar fasciitis is certainly the most frequent problem and is generally simple to diagnose. However, there are plenty of other causes that aren't as frequent and are more difficult to diagnose. One of the less frequent conditions is a disorder 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 walking or running. Usually there is sufficient fat there to provide that protection, but in some people it atrophies or wastes away and it might no longer guard the heel with that shock reduction. The reason why it happens is not completely obvious, but there is some atrophy of that fat pad with ageing and some just seem to atrophy a lot more than others at a faster rate. The primary signs of this problem are increasing pain with standing and walking underneath the heel. It is also essential to eliminate other conditions because they might exist concurrently.
The primary approach to manage heel pad atrophy is to replace the fat that has wasted away. The simplest way is to use pads in the shoe underneath the heel, preferably made from a silicone gel that has the same consistency as the natural fat, since they technically replace the pad that is missing. This usually handles just about all cases of this and this is all that has to be done. A possible problem with this approach is you have to wear the pads and you can’t do this 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 can come from another part of the body or may be artificially made in the laboratory. The longer term outcomes of this sort of approach aren't yet known, but early results from the procedure appear good.