A bruised heel, medically known as a calcaneal contusion, is a painful injury resulting from a direct impact or excessive, repetitive force to the bottom of the foot. The heel bone (calcaneus) is cushioned by a thick, protective fat pad designed to absorb shock. When the force exceeds what this padding can handle, the underlying tissues and potentially the bone suffer damage. This injury causes intense discomfort, often making it difficult or impossible to bear weight on the affected foot.
Defining the Injury and Symptoms
A heel contusion involves trauma to the soft tissues, including the fat pad encasing the calcaneus, and sometimes the periosteum (the thin membrane covering the bone). The anatomical structures are compressed and damaged, leading to internal bleeding and inflammation. This results in a sharp, deep pain localized distinctly under the heel bone.
The distinguishing symptom is pain that intensifies when pressure is applied directly to the center of the heel, such as when standing or walking. While a visible bruise may appear on the sole, the injury is often internal and localized to the fat pad. This acute pain usually results from a single traumatic event, differentiating it from chronic issues like plantar fasciitis, which typically hurts most after periods of rest.
Primary Causes of Heel Contusion
The causes of a bruised heel fall into two main categories: acute trauma and repetitive impact, both involving excessive force on the calcaneus. Acute trauma involves a sudden, high-force event, such as jumping from a height and landing directly on the heels. Stepping unexpectedly on a hard, sharp object, like a stone, can also cause an immediate contusion by compressing the fat pad against the bone.
Repetitive impact injuries occur over time when the heel is subjected to smaller, continuous forces that gradually degrade the protective tissues. This is common in activities involving repeated pounding, such as long-distance running, basketball, or gymnastics. Running with a hard heel-strike pattern on unforgiving surfaces, like concrete, significantly increases this risk.
Improper or worn-out footwear is a contributing factor because it fails to provide adequate shock absorption and cushioning. Shoes with insufficient support lead to a breakdown of the fat pad’s natural elasticity, increasing stress transmitted directly to the calcaneus. Being overweight or rapidly increasing workout intensity without proper conditioning also places excessive pressure on the heel, making it vulnerable to contusion.
Immediate Care and Recovery Steps
Immediate management of a heel contusion involves adhering to the R.I.C.E. protocol: Rest, Ice, Compression, and Elevation. Rest is paramount, requiring the affected foot to be kept non-weight-bearing for at least 24 to 48 hours to prevent further damage. Applying ice wrapped in a thin towel to the heel for 15 to 20 minutes helps reduce pain and local swelling.
Compression with an elastic bandage controls swelling, but must be snug without causing numbness. Elevating the foot above the heart uses gravity to decrease fluid accumulation, especially during the first few days. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can manage pain and inflammation during the initial recovery phase.
Recovery typically spans one to three weeks for a fat pad contusion, during which protective cushioning is necessary. Specialized heel cups or orthotic inserts redistribute pressure away from the injury site, facilitating healing while allowing limited weight-bearing activity. Avoid returning to high-impact activities until the pain has completely resolved to prevent the injury from becoming chronic.
When Professional Medical Attention Is Necessary
While most heel contusions heal with home care, certain symptoms indicate a more serious injury, such as a calcaneal stress fracture or a complete fracture. Consult a medical professional if there is an inability to bear any weight on the foot immediately following the injury, or if the pain is severe and unmanageable with home treatments.
You should also seek professional help if the pain worsens or fails to improve after two weeks of consistent rest and home management. Numbness, tingling, or a feeling of coldness in the foot can signal potential nerve involvement or issues with blood circulation and require prompt evaluation. A doctor can perform a physical examination and may use imaging studies, such as X-rays, to accurately diagnose the injury and rule out a fracture.