Under the bottom of the heel is a fat pad that normally cushions us and protects the heel as we walk. When walking, there is a force equal to approximatly 2.5 times our weight on the heel during heel strike, so that it ought to be no surprise that we require that fat pad. Without that fat pad there would be poor cushioning and this may result in a number of problems resulting from that inadequate shock absorption. The most common is simply soreness below the heel. The pain will mostly show up on weightbearing and not so much on palpation. This may not be a common reason for heel pain, however it is a vital reason as it might often be wrongly identified as heel spurs as well as other causes. Typically it is simple to diagnose as there is just virtually no cushioning underneath the heel and you will easily feel the calcaneus.
The causes of fat pad atrophy aren't completely understood. The fat pad does waste away as we grow old normally and in some it simply atrophies more at a faster rate. Some people simply appear to get this while others will not. It is not linked to bodyweight problems. It could occur in some rheumatological problems and runners due to the many years of beating on the rearfoot may perhaps be at a greater risk for this. People with a higher arched foot (pes cavus) will also get a shifting of this fat pad which can make a similar issue to the atrophy.
The only method to treat fat pad atrophy will be to replace the fat or substitute for the fat. This can be inserted in surgically or a cushioning heel pad in the shoes used that has a equivalent consistency to the atrophied fat pad. Cushioned shoes could also be used with or without extra cushioning. Operatively this could be an injectable fillers or an autograft utilizing your own fat tissue.