Heel pain frequently occurs and there are many different reasons for this. Plantar fasciitis is by far the most common problem and is typically easy to diagnose. However, there are numerous other reasons that are not as frequent and are harder to diagnose. One of the less common conditions is a disorder referred to as heel fat pad atrophy. There is a covering of fat under the heel that acts as a cushion and shock absorber when we are running or walking. Generally there is plenty of fat there to provide that shock absorption, however in some people it atrophies or wastes away and it can no longer protect the heel with that cushioning. The reason why it occurs is not completely clear, there is however some atrophy of that fat pad with ageing and some simply appear to atrophy more than others at a faster rate. The primary symptoms of fat pad atrophy are usually increasing pain with standing and walking under the heel. It is also essential to exclude other causes 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 wear pads in the footwear beneath the heel, usually made from a silicone gel which has the same consistency as the natural fat, as they technically replace the pad that is missing. This commonly handles the majority of cases of this and that is all that needs to be done. The only problem with this method is you have to use the pads and you can’t do that when without shoes or in sandals without difficulty. The only other option is a surgical procedure called augmentation in which some fat is surgically implanted beneath the heel. The inserted fat may come from another area of the body or could be artificially created in the laboratory. The longer term outcomes of this sort of method are not yet known, however early results from the procedure appear excellent.