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How to Identify & Treat Heel Bruises

August 22, 2012

heel bruiseA heel bruise, aka a stone bruise or a calcaneal fat pad contusion, is caused by excess force directed to the bottom of the heel.

How the fat pad works

This specialized fat pad works much like a mattress as it cushions normal heel strikes and prevents the calcaneus (heel bone) from getting directly injured. Common ways people bruise their heel include:

  • Jumping and landing from a high place
  • Running with a heel strike instead of forefoot landing (see our discussions on barefoot running)
  • Stepping on a small stone

What happens during the injury

Heel bruising is caused by excessive force to the bottom of the heel. Depending on the energy of the injury the fat pad can be:

  • Contused (minor bruise with bleeding into the tissue)
  • Partially disrupted (split in half)
  • Completely disrupted (torn away from the bottom of the heel bone)

In higher energy injury cases, the calcaneus bone itself can be fractured

How to treat

Rest, Ice, Compression, and Elevation. Rest is the most important and the hardest to do. Foot problems are so prevalent in our society because we never give our feet a break. Professional athletes are some of the worst offenders at trying to return to activity too early.

What can go wrong

Returning to activity too quickly will not allow the fat pad to heal completely, resulting in a new bruise and resetting the healing process.

If excessive scarring forms, it can trap nerves that run through the bottom of the heel. These nerves don’t get better without release of the scar tissue. While surgery and the recovery are easy, making the diagnosis is quite challenging as it is almost always mistaken for Plantar Fasciitis. Skilled ankle and foot surgeons will spend the time necessary to make the distinction.

From → Heel injury

48 Comments
  1. Mark Berger permalink

    good to know

    m

  2. A bruised heel can be caused by either a sudden impact or repetitive pounding. Taping it up helps relieve the pain but the only way to effectively treat a bruised heel is rest. Wrap an elastic bandage around the bruise. This will also help to reduce the blood flow in the bruised area, and prevent veins from leaking. Always wear sturdy, supportive shoes and add a properly fitted arch support.

    • Excellent advice Tracy. Thanks for your comments!

      • Lmccranie permalink

        “A bruised heel can be caused by either a sudden impact or repetitive pounding. Taping it up helps relieve the pain but the only way to effectively treat a bruised heel is rest. Wrap an elastic bandage around the bruise. This will also help to reduce the blood flow in the bruised area, and prevent veins from leaking. Always wear sturdy, supportive shoes and add a properly fitted arch support.”
        You commented that this was great advice, which I am following along with the RICE principal after suffering a heel bruise. Unfortunately, I was unaware that I had a heel bruise until two days after it occurred… I thought it was just sore from a sudden impact fall off of my paddle board. Am I too late to use the RICE principal here now that I am two days into this injury. We travel in one week and I want to heal as much as possible before then.. Please advise…

      • anklefootmd permalink

        Its never to late to give it a break. POLICE is better than RICE, though: Protection, Optimal Loading, Ice, Compression, Elevation. Aka avoid overstressing your foot, regularly ice it for 15-20 minutes every 2-3 hours, and keep it elevated as much as possible.

  3. Liz Gaines permalink

    Thanks so much for this information. I injured my heel 18 months ago during a 5K trail run wearing my low profile cross-fit workout shoes. Then continued for six more months with cross-fit doing exercises like box jumps, jump rope, etc. Despite this background information 3 of the 4 podiatrists I have seen said it was Plantar Fasciitis (yes it hurts first thing in the morning, but also after being on my feet for an hour or so – at that point I am hobbling, limping from the pain – but this has just been for the last several months). Only the 4th one that I went to today said he thought it was a lack of heel pad and prescribed 4-6 weeks on crutches (plus icing). It will be inconvenient but I finally feel like I am on the right track.

  4. noris tavant permalink

    i stamp my feet as i was jumping off the sofa height to the floor. I did it few times before and it hurt for a 5-10min. Last two days.. i think i was too sleepy. i swing again and stamp my foot. this time, it hurts for 3 days. No signs of bruising.. its painful when i squeeze on both side heel.. and applying pressure. but i also cannot put too much pressure on left bottom. it hurts too. the fatty pad side doesnt hurt.. it just right infront of the fatty part hurt. inner part.. so is it heel contusion ?

    • It’s unclear exactly what exactly you have, but if you have trouble bearing weight you should go obtain an evaluation by a physician. I hope your feet start to feel better.

  5. Emilie permalink

    I jammed my heel against a base while playing softball a week ago. It hurts and I have a hard time putting pressure on it while walking. I went for an X-ray today and was told there wasn’t an obvious fracture. Is my best bet to stay off of it and to ice and elevate? And should I hold off on returning to work until I can put pressure on my foot without pain?

    • Ouch. Heel bruises can hurt. The bone may not be fractured in some injuries, but it can be bruised. These take months to resolve in some of the worst cases. Wearing a heel cushion can help.

      I will often put patients with bad heel bruises into a boot and offer crutches if it’s still painful. You always need to be concerned about a plantar fascia injury/rupture in the history you provided. Depending on your line of work, if you can manage with the help of a boot and/or crutches, that may be your best bet.

      Remember time heals all wounds, even those of the heel.

  6. I bruised my heel a few months ago and it still hurts. Hard to walk when I wake. I recently had to drive a long distance and that did not help. When you say “compression” as part of the treatment, what actually does that entail. Not able to go to the doctors at this time.

    • Hey Larry,

      Patients with symptoms like yours are more likely to have plantar fasciitis from those types of symptoms. You should seek advice from a qualified foot and ankle doctor in your area. There are plenty of non surgical treatments available, and your doctor can walk you through those options as well as discuss compression techniques. Hope your foot pain fades soon!

  7. George permalink

    (September 2012) I fell about 15 feet and landed on my right heel, outside edge. After the intial X-rays did not show a fracture I was recommended to a podiatrist. He diagnosed plantar-faciatis and gave me a cortisone shot in two places on my heel, in addition to prescription anti-inflammatory medicine.

    After months of pain, I sought another podiatrist(Dr #2.). After X-rays did not show anything, he sent me to physical therapy, which I attended for two months. I left pain free, believing I was 100% and slowly resumed mid-distance running and Olympic style power-lifting. (April 2013)

    After increasing the weights to 335 for squat and 350 for deadlift, I began to have the same heel pain. (October 2013) I have since nixed all squats, deadlifts, and other compound lifts that involve my feet. Revisiting Dr #2, he diagnosed me with tendonitis and sent me back to physical therapy, after fitting me with orthotics (Which were not cheap!). I’ve had three weeks in physical therapy (Same therapist as seen earlier in the year), and my foot pain is increasing.
    I have a follow-up appointment next week, and I will push to get an MRI done.

    I’m considering getting a second opinion or perhaps even a surgical consult. Can you please advise on on the best course of action?

    I ship for Army officer school in March, and injuries of any kind are not looked kindly upon; doubly so for feet. With 165 folks in one class and a 30% attrition rate you can see my cause for concern.

    • The story is told well, but there is a good physical examination missing. If the bone wasn’t broken and there was an interval of being pain free, this is likely a ligamentous problem. The diagnosis of tendinitis is generally seen in ligament problems.

      Physical therapy is good treatment, but this may be a cycle: PT, feel better, go back to activity, hurt again, etc.

      My recommendation for patients with this typical cycle is to evaluate and see if instability is causing the disorder. An MRI will show old and new tears and other occult injuries, but it won’t tell you if the joints are stable or not.

      • George permalink

        Update:

        I saw Dr #2 earlier this week and had an MRI done; the results were surprising. Tendinitis of the peroneus longus, and a 12MM osteochondral lesion + subchondral lesion. I have been referred to an orthopedic surgeon for a consult : (

        I am still headed to get a second opinion next week for good measure.

      • The ankle is likely unstable in these cases. Expect a good exam to demonstrate that. 

        - Lance Silverman M.D.

        952-224-8500 office 952-224-8515 fax 952-649-0068 cell

        Silverman Ankle & Foot http://www.anklefootmd.com Follow us on FB, Twitter, Google+ blog.anklefootmd.com

        On Fri, Nov 15, 2013 at 9:36 AM, Minnesota Ankle & Foot Blog

  8. Oy. I did a stupid thing and jumped 6-7 feet onto a concrete bunker in the S. Pacific – in bare feet. My R heel/foot has been excruciatingly painful ever since, though I’m still able to walk. Swelling on outside of heel continues 9 days later.

    I presume this is a bruise and not a fracture, as I am still able to walk. Unfortunately, I am overseas and do not have much ability to RICE.

    Should I really be making the effort to stay off the foot? if so, I’ll miss my whole planned trip.

    Thank you.

    Clay Evans

    • Hey Clay,

      You cannot assume anything after a fall with that energy imparted to the heel bone. You could have a fracture.
      It is important to get an X-ray, but it is tough to find anything but solar radiation in the South Pacific.
      Without an X-ray, I am at a loss to give anything other than the most over protective advice: people with this type of injury can have solely a heel bruise or can have a displaced calcaneus fracture requiring surgery. Let’s hope it’s the former. RICE when possible for the time being.

      Best of luck,

      Dr. Silverman

  9. Claire permalink

    Hi, I bruised my heel almost 5 months ago. It is better but hard to completely fix. When I rest it completely, it improves, but then I guess I start going for walks and it hurts more. So I’ve resigned myself to complete rest now. Podiatrist I saw 2 months ago just said ice, elevation, and it would be completely gone in 6 weeks. It’s longer than 6 weeks though, and I really want my heel bone bruise to away. Do you have any advice? Thank you very much.

  10. Claire H permalink

    Hi, I bruised my heel 5 months ago. 3 months ago the podiatrist did an x-ray, found nothing, and called it a bone bruise. He said ice, elevation, and it would be gone in 6 weeks. When it started getting better I started going for walks on it, which made it hurt more. So I have decided to mostly rest it with a little bit of walking.I don’t understand why it is taking so long. How much more healing time do you think I have before the heel bruise is gone? Thank you very much

    • Heel bruises are trouble. It’s an area that once its damaged takes a long time to heal and every step we take reminds us about the injury.

      How the injury occurred, what other symptoms are present, and where and when it hurts are key to making the right diagnosis and then the right treatment.

      Some heel bruises are irreversible injuries. Some damage the muscles in the bottom of the foot and can be treated. Some damage the nerves on the bottom of the foot and can be treated. Some damage the plantar fascia and can be treated.

      What tissue or tissues were injured, I don’t know. I wish I could help you but, you need to find someone to examine the tissue to figure it out.

      Best of luck in your recovery, Claire. I hope it heals soon.

  11. Hilde permalink

    I have a high arch and am having tremendous pain on my left foot right side closest to the back of the arch. I wear wedge heels or heels and the pain is better but when I try to wear running shoes the pain gets worse. What is wrong? I have not seen a doctor yet. Should I buy wedge tennis shoes? Insert? I wear running shoes when I go to the gym and come out limping.

    • Sorry to hear about your pain, Hilde. In patients with heel pain with activity, I recommended that they stop landing on the heel; consider changing to a barefoot style landing (even in shoes).
      Sometimes patients with this problem have an entrapped nerve (Baxter’s nerve). A cortisone injection that is placed near the nerve (not the plantar fascia) has very good results. Consider experimenting with a forefoot-striking running style and see if you notice less pain. I hope it works for you.

  12. crissy permalink

    I actually bruised my heel from a fall down the stairs I noticed that I had a bruise which really hurt but its hard for me to give my foot rest because I have a dance recital so I have to be rehearsing but I am now well aware of what can go wrong so thank you

  13. Sharky permalink

    Hi, I recently landed hard on my heel after the hop in triple jump and hurt my heel. After the first jump I had to pull out of the competition because I did not want to risk hurting it more. It was 2 days ago and it hurts to walk. How long do heel bruises take to completely heal? When can I start jumping/bounding training again?

  14. I have a deep heel bruise, since the November 2013 Soccer Playoffs. The heel feels painful and I am afraid to officiate again thinking the Achilles will rupture; had that on the other foot and it was painful. I was just running along the touchline and a sudden pain on the right heel and still there. What is the best advise?

    • Pain on the back of the heel is likely Achilles tendonitis. Pain on the bottom that doesn’t resolve may be a heel bruise, but more likely is due to a partial plantar fascia tear. Obviously you would need an in-person evaluation for a true diagnosis, but your symptoms sound very familiar. The blog below can help give you a couple of ideas for non-surgical treatment options to try to alleviate the pain. If pain continues to persist, see a specialist.

      http://blog.anklefootmd.com/2012/06/29/how-to-know-if-you-have-plantar-fasciitis/

  15. Catherine B permalink

    Six months ago I was out drinking with friends and we were doing a lot of dancing. I was wearing ballet pumps so not much support. A guy also accidentally kicked me in the back of the heel when dancing. The next morning I couldn’t put weight on the heel it was very painful. After rest and wearing trainers to work it got a bit better and I could workout and wear different shoes. I would feel a twinge now and then but it wasn’t too bad. Sometimes I felt nothing.

    Two months or so ago I went to New York and was walking a fair but and the pain got really bad. I had to sit down all the time and developed Achilles tendinitis symptoms also.

    An X-Ray showed nothing but an MRI showed a stress reaction of some kind in the heel as well as Achilles tendinitis. But the ortho surgeon wasn’t 100% what was causing the heel pain. I’m in an airboot with crutches two weeks in. Taping the heel also reduces pain. The pain feels sharp when I press the centre of the heel or stand on it. I also get dull aches and tingling when resting.

    I’ve been told I have HYPERMOBILE ankles could this lead to my symptoms?

    After so long of not knowing I’m desperate for any advice.

    Many thanks

    Catherine

    • Catherine,

      In patients with a history like you describe, the treatment you have received sounds top notch. It is exactly what I would have done. If I had to guess this is what was happening to your foot from the scenario you described:

      A patient with pre-existing ankle instability gets a direct contusion to the calcaneus causing a stress reaction/incomplete fracture. In the ensuing few weeks the bone heals by decreasing activity, but the Achilles tendinitis and retro calcaneal bursitis develops as the muscles that had been stabilizing the ankle became weaker while compensating for the injury. The whole back of the ankle and heel get overloaded during the increase in activity (which occurs with every trip to NYC as walking is a way of life there). Swelling of the whole area then entraps the distal tarsal tunnel giving the sensation of pain in the medial calcaneal branch and along baxter’s nerve which explains the symptoms at rest.
      Yes, I have seen this pattern a few times prior.

      So, the boot is a great method to drop the swelling, but in patients with this presentation, obtaining stability and strength is a goal. After a few weeks in the boot I would give a tarsal tunnel injection to add to the overall decrease in inflammation. Then, I’d move to an ankle stabilizing brace such as a trilock foot brace in conjunction with aggressive strengthening and balance training in physical therapy. However, if I identified mechanical ankle instability on a clinical exam, I would recommend the patient consider ankle ligament reconstruction.

      This pattern is bound to repeat. Look at all basketball players with repeat ankle troubles. Even with their great trainers, they keep having ankle problems like this that put them out. They rehab only to recur their troubles.

      Hope that helps answer some of your questions. Best of luck in your recovery!

      • Catherine permalink

        Thank you so much for your reply.

        Would you suggest I avoid all strengthening exercises until im out the boot and feeling no pain in the heel?
        Once I do commence these exercises, I
        plan to do work with a theraband and wobble board work. Is this
        sufficient?

        Could you advise how many weeks I should spend in the boot in your opinion before trying to walk on the heel?
        Finally, an additional symptom I have is a cracking sensation when bearing weight on the heal. Might this be a side effect of the inflammation? Im using ice
        and NSAIDs to reduce this but is there
        anything else I can do myself?

        Many thanks indeed for your time.
        Catherine

        Catherine

      • In patients who describe the problems you are referring to:

        I only keep them immobilized enough for the acute inflammation to resolve (3-4 weeks). During that time, I transition them into physical therapy for strengthening.

        As far as crackling and popping sensations, if they don’t hurt, I don’t treat them, If they do, they are a sign of bursitis in most circumstances and benefit from a cortisone injection and strengthening in a stable position.

        Best wishes,
        Lance Silverman

  16. Catherine B permalink

    It’s also worth noting the MRI showed no plantar fasciitis. I had ultrasound and laser and massage for plantar f as that was the original diagnosis. Needless to say it didn’t help as seems it was an incorrect diagnosis.

  17. Ella permalink

    8months ago I failed during a lions chase obstacle race and bruised my heel really bad. I went to doctor had an X-ray and it’s not broke. He told me rest it and to alternate heat and ice for few day’s.I did it and it helped some, the swelling went down some but not completely .I also went to a chiropractor he X-ray and adjusted, felt a little better but my heel is still swollen after 8 months. What should I do?will it ever go back to normal?

    • anklefootmd permalink

      Ella,

      If you’re still dealing with pain and swelling eight months post injury, odds are you broke something that the X-ray didn’t catch the first time. I would have it looked at again by a doctor. Best of luck on your recovery.

      Dr. Silverman

  18. Ella permalink

    Thank you! Do you think that I should see a podiatrist or just my physician ? Will an X-Ray be enough of do I need an MRI ?

    • anklefootmd permalink

      Ella,

      An xray is usually good enough. A MRI may be ordered depending on the kind of heel pain, but you should see an Orthopedic surgeon who specializes in the ankle and foot. Please see the orthopedic difference at AOFAS.org and do a Google search for a local orthopedic surgeon with Ankle and Foot specialty credentials in your area.

      Best,
      Dr. Silverman

  19. Hi ! I have pain in my Heel .Its not severe pain but I cannot Stand and Walk Properly and also I can’t put my weight on my injured Heel . I actually kicked the Bed with my Heel on the Sharp side and from then I have Pain . I hope and think it is not fractured . Kindly tell me about some cure of it ! I’ll be Very Thankful to you !
    Regards !

    • anklefootmd permalink

      Munib,

      You should see a doctor and get an X-ray. Fracture is a possibility. I hope the pain subsides.

      Dr. Silverman

      • Sir the Pain is not very severe and Heel is also not fractured in X-ray . I can walk but I can’t put my bodyweight on the affected side of the foot. Actually I got injury on the curved side of the heel . I don’t feel pain when I’m sitting . It only pain when I put my bodyweight on that side . Kindly tell me a cure So i can play Football . :)
        THanks !

      • anklefootmd permalink

        If it’s not fractured on X-Ray, how old is this injury?

  20. Sir let me mention that I have no Swelling !

  21. Sir the Pain is not very severe and Heel is also not fractured in X-ray . I can walk but I can’t put my bodyweight on the affected side of the foot. Actually I got injury on the curved side of the heel . I don’t feel pain when I’m sitting . It only pain when I put my bodyweight on that side . Kindly tell me a cure So i can play Football . :)
    THanks !

  22. Sir ya Its Not fractured in X-ray .. Its just 3 DAys old and I am now feeling better. I mean it is healing .. But its not completely healed .I still get pain When i run and little pain when I stand .

  23. Suzanne Slayton permalink

    I have been diagnosed with a bruised heel following some issues with a neuroma while running. I’ve not run for almost 5 weeks now but have still been doing some cross training such as the elliptical and rowing machine. Still have lots of pain in heel. How long does it usually take to heal and I’m I continuing to injure by doing the cross training? My doctor did an x-ray and nothing was fractured. Hurts worse at the end of the day than in the morning so I feel that diagnosis is accurate. I wear a lot of sandals this time of the year and when I put on sneakers to do workout it hurts in those too. Just frustrated and not sure that I’m doing what’s best!

  24. Jane permalink

    My daughter hit a hurdle whilst training with the inside of her heel and fell to the ground. She rested the injury as much as she could for 2 days, has done non weight bearing exercises for 2 days (eg cycling) and I have been massaging the foot and applying arnica. She iced it at the start to stop any inflammation and is now using heat as well. Whilst the pain has subsided and she can walk, her foot still hurts on the inside, now running from the heel down under the arch. She cannot run without pain. She has a major competition (National Finals) coming up in 3 days and I am wondering if there is anything more she should be doing to give her a chance of being able to compete. Much appreciate any advice you can give her.

    • anklefootmd permalink

      It’s hard to know what area was injured. It is unlikely she caused major damage to herself striking the hurdle. If this was the inside of the heel that struck (the trailing leg), there are a lot of structures that could be affected from the calcaneus (bone contusion) to the tarsal tunnel (tendons and nerves). If the injury was before she left the ground it could have been something inside the foot that tore like the plantar fascia or another ligament If the injury was upon landing after striking the hurdle, who knows what could have been injured in the precarious hurdling position during a fall on the hurdle. I wish I could be of more help. Rest, Ice, Elevation and Ibuprofen are her best bets in the short term.

  25. Katelyn permalink

    So my fiance decided to jump from a one story roof, and hurt his heel. He said when he landed he locked his leg and all the force went directly on his right heel. Is this possibly a bruised heel? He was able to walk home, this morning it wad very hard to put any sort of pressure on and part of that foot. We are going to the local Dr today or tomorrow but wanted to know what to maybe expect!

    • anklefootmd permalink

      This could be a fractured calcaneus and he needs X-rays, or it could be a heel bruise. Either way this heel is going to hurt for some time after a fall/jump from a height.
      Best of luck, Katelyn.

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