Underneath the plantar surface of the rearfoot is a fat pad that naturally cushions us and guards us as we walk. When walking, there exists a force equal to around 2.5 times body weight on the heel during heel strike, therefore it must be no surprise that we require that fat pad. Without that fat pad there would definitely be very poor shock reducing which can bring about a number of conditions because of that inadequate padding. The commonest is simply pain under the heel. The pain sensation will largely show up on weightbearing instead of as much on pressing on it. This may not be a frequent source of heel pain, but it is an important reason as it could often be wrongly identified as heel spurs and other reasons. Commonly it is not difficult to diagnose as there is certainly just no cushioning under the heel and you can easily feel the calcaneus.
What causes fat pad atrophy are certainly not completely clear. The fat pad does waste away as we grow older normally and in many it just wastes away more at a faster rate. A number of people just seem to develop this and others usually do not. It's not necessarily related to bodyweight concerns. It might appear in numerous rheumatological conditions and athletes due to the years of pounding on the heel may perhaps be at a greater risk this condition. Those with a higher arched foot (pes cavus) will also get a displacement of this fat pad which might make a similar problem to the atrophy.
The only way to treat fat pad atrophy would be to replace the fat or substitute for the fat. This may be inserted in surgically or a cushioning heel pad in the shoes used that has a equivalent uniformity to the atrophied fat pad. Padded shoes could also be used with or without extra cushioning. Operatively this can be an injectable fillers or perhaps an autograft using your own fat cells.