A “stone bruise” is a common term for a sharp, localized pain in the heel, which medical professionals refer to as a calcaneal contusion. This injury is essentially a bruise to the tissues surrounding the heel bone, or calcaneus, and can be quite painful when bearing weight. It results from a sudden, forceful impact that damages the delicate structures in the sole of the foot. The pain is typically felt immediately upon impact and is centered in one specific spot on the heel’s underside.
Understanding Calcaneal Contusion
A contusion involves bruising or damage to soft tissue, which in the heel primarily affects the protective fat pad. The calcaneus, or heel bone, is the largest bone in the foot and is naturally exposed to high impact forces as it makes contact with the ground during movement.
Beneath the calcaneus lies the heel fat pad, a specialized layer of adipose tissue compartmentalized by fibrous bands. This pad functions as the foot’s main shock absorber, cushioning the bone from the forces of movement. A stone bruise occurs when an impact compresses and damages this fat pad, leading to localized bleeding and inflammation within the tissue. This damage can sometimes affect the calcaneus itself, causing a bone bruise. Key symptoms include sharp pain when pressing directly on the heel, tenderness, and potentially visible swelling.
Specific Mechanisms Leading to Injury
A stone bruise results from two primary mechanisms involving excessive force on the heel. The first is acute trauma, often suggested by the name “stone bruise.” This involves a single, sudden, high-force impact, such as stepping onto a small, sharp object like a pebble or rock. A fall from a height or a hard landing during a jump can also generate enough force to cause damage.
The second mechanism involves repetitive microtrauma, where less severe but repeated impacts gradually overwhelm the heel pad’s shock absorption capacity. This is common in high-impact activities like running, jumping sports, or marching, especially on hard surfaces like concrete. Repeated forces cause chronic irritation and inflammation in the heel pad tissue. Contributing factors include wearing footwear with thin or worn-out soles that lack cushioning, poor foot strike mechanics, and a rapid increase in training intensity.
Immediate Management and Healing
Immediate management focuses on reducing inflammation and preventing further damage. Initial care involves the R.I.C.E. protocol. Rest the foot to offload the heel and avoid painful activities. Apply ice to the affected area for about 20 minutes at a time, several times a day, to decrease pain and swelling. Compression and elevation (raising the foot above heart level) minimize fluid accumulation.
During the healing phase, minimize direct pressure using supportive measures. Wear comfortable shoes with soft, shock-absorbing materials, or use specialized heel pads or cushioned orthotic inserts to redistribute pressure away from the tender spot. Mild contusions involving only the fat pad usually resolve within one to three weeks. If the calcaneus bone is bruised, recovery may extend to four to six weeks. If pain is severe, walking remains difficult, or symptoms persist beyond two weeks of home care, seek medical evaluation to rule out a stress fracture or calcaneal fracture.
Strategies for Long-Term Prevention
Proactive steps are necessary to prevent the recurrence of a calcaneal contusion by improving the foot’s shock absorption capacity. Selecting proper footwear is a primary defense; shoes should have thick, firm midsoles and well-cushioned heel cups. Avoiding walking barefoot on hard surfaces, such as hardwood floors or concrete, removes a common source of impact stress.
For individuals engaging in high-impact exercise, custom or over-the-counter supportive insoles can provide arch support and help evenly distribute weight, reducing the load on the heel fat pad. It is beneficial to gradually introduce new high-impact activities or increases in intensity. This allows the foot structures time to adapt to the new forces. Maintaining a healthy body weight is effective, as excess weight places a greater compressive force on the heels with every step.