Pain in the heel is common and there are a number of causes of that. Plantar fasciitis is certainly the most frequent condition and is often easy to diagnose. However, there are plenty of other reasons that aren't as common and are more difficult to diagnose. Among the less frequent conditions is a disorder referred to as heel fat pad atrophy. There is a covering of fat beneath the heel that acts as a cushion and shock absorber while we are walking or running. Generally there's plenty of fat there to provide that protection, however in some people it atrophies or wastes away and it may no longer protect the heel with that shock reduction. The reason why it happens isn't entirely clear, there is however some atrophy of that fat pad with aging and some just seem to atrophy more than others quicker. The main symptoms of this problem are increasing pain with weight bearing under the heel. It is also essential to exclude other causes because they could exist concurrently.
The primary approach to deal with heel pad atrophy is to replace the fat which has wasted away. The easiest way is to wear pads in the shoe beneath the heel, usually made from a silicone gel which has the identical consistency as the natural fat, since they technically replace the pad which is wasted. This generally handles the majority of cases of this and this is all that needs to be done. A possible problem with this method is that you have to use 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 in which some fat is surgically implanted beneath the heel. The inserted fat may come from another part of the body or might be artificially created in the laboratory. The longer term results of this type of surgery aren't yet known, however early results from the procedure appear good.