A localized patient support comprises a base, an annular ring supported above the base and defining a cavity, and a gel pad having a plurality of sections located in the cavity. In some embodiment, the localized patient support includes an insert received in the cavity and located between the base and the gel pad. At least some of the sections of the gel pad located in the cavity are vertically movable substantially independently of adjacent sections of the gel pad. In some embodiments, the base, the annular ring, and the insert comprise foam elements. In other embodiments, the base and the annular ring comprise foam elements and the insert comprises individually inflatable and deflatable air bladders.