Bruised Heel (Fat Pad Contusion)

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Bruised Heel (Fat Pad Contusion) 2018-01-11T20:02:51+00:00

Bruised Heel (Fat Pad Contusion)

By Terry Zeigler, EdD, ATC 

Sports participation can place the foot at risk for a number of injuries including a bruised heel. Because the calcaneus is the largest bone in the foot and the primary weight bearing bone, it is subject to injury. Although ankle sprains are the most common ankle/foot injury, a heel bruise can be quite debilitating.

A heel bruise can be a painful injury and can be the result of either one acute injury or from repetitive impact on the foot. Although moderate injuries can result in a contusion to the fat pad surrounding the calcaneus or a deep bone bruise, repetitive injuries can result in a calcaneal stress fracture.

What is a bruised heel?

The calcaneus is the bone in the foot that bears most of the weight during the heel strike phase of an athlete’s forward movement. The weight of the athlete is transferred from the tibia through the talus (smaller tarsal bone) and to the calcaneus during heel strike before the athlete’s weight is transferred through the other small tarsal bones on through the metatarsals and out through the toes.

The calcaneus is at risk for injury because it is the sole bone that makes initial contact with the ground when the athlete walks, jogs, or lands from a jump. Surrounding the calcaneus is elastic adipose (fat) tissue for the purpose of cushioning and protecting the calcaneus from impact injuries.

Regardless of the cause, the outcome to the athlete is a painful bruising on the bottom of the heel that causes significant pain to the athlete when weight-bearing.

What is the classification of heel injuries? 

A heel injury can include a range of injuries from mild (bruise) to moderate (stress fracture or bone bruise) to severe (fracture of the calcaneus). The severity of the injury depends on the amount of force placed on the calcaneus.

An injury resulting in a heel bruise may result in pain during walking or weight bearing, swelling in and around the heel, and tenderness of the heel to pressure. Injury to the heel pad might also result in displacement of the heel pad laterally and medially (to either side) resulting in a flat spot under the calcaneus compared to the uninjured foot. If the athlete continues to work out on a bruised heel, the injury may develop into chronic inflammation of the periosteum (outside perimeter of the bone) a much more debilitating injury.

Calcaneal stress fractures have been associated with excessive marching (as in the military) on hard surfaces in boots without quality shock absorption or in long distance runners. Besides calcaneal stress fractures, other bones that have a higher risk for stress fracture in the foot include the navicular, the metatarsals, and the sesamoid bones (underneath the head of the first metatarsal). bruised heel

A complete fracture of the calcaneus needs a significant amount of force. One type of force strong enough to fracture the calcaneus is seen in the sport of sky diving during the landing phase (calcaneus can be shattered on a hard landing). Although deformity is not usually associated with a fractured calcaneus, the athlete would not be able to walk and would have immediate swelling and pain.

How is a bruised heel diagnosed? 

A bruised heel can be diagnosed by a sports medicine professional through a thorough medical history and clinical evaluation. If a stress fracture is suspected, the physician may order a bone scan. A fractured calcaneus can be detected through the use of a routine x-ray. 

Who gets a bruised heel? 

Although thicker bones are generally more resistant to stress injuries, athletes who repetitively land from jumping may be at risk for heel bruises. According to Bahr and Maehlum (2004), “long jumpers and triple jumpers are particularly vulnerable” to this type of injury.

However, any athlete participating in a sport that requires repetitive landing on the feet can be at risk for this type of injury. This might include athletes in the sports of indoor volleyball, basketball, beach volleyball, and long distance running.

What causes a bruised heel? 

The foot is subject to stress anytime an athlete runs, jumps, and changes directions. However, specific factors may place an athlete at risk for heel injuries including the following:

• Excessive body weight
• Age
• Poorly cushioned or worn-out running shoes
• Increases in training
• Hard, uneven training surfaces
• Walking or training barefoot

A heel bruise can be caused by a one-time incident of the athlete landing on his/her heel from a height (or in poor shoes) or from repetitive trauma over time (running on the beach without shoes).

What can I do to prevent a bruised heel? 

Reviewing the factors that may place an athlete at risk for heel bruise is a good place to start to prevent a heel injury. Because shoes with poor shock absorption may place an athlete at risk for heel injuries, careful selection of shoes should be a priority for athletes especially in sports that require a lot of running, jumping, and changes of direction.

Runners should replace their shoes often so as to ensure that the quality of the shock absorption components of the shoe is still effective and able to prevent heel injuries. Athletes should research shoe designs and purchase a shoe that is specifically designed for their sport and for their foot.

Athletes should also take care to wear shoes when training especially when training on uneven surfaces like the beach. Athletes may mistakenly believe that the soft surface of the sand may prevent injuries to the foot, but the outcome of a run on the sand may be the opposite.

Along with sustaining heel injuries from running barefoot on the beach; uneven surfaces may also cause injury to the muscles on the inside and/or outside of the ankle (strained peroneal muscles and/or strained tibialis posterior).

What is the treatment for a bruised heel? 

The treatment goals are to reduce the pain and swelling and prevent any further injury. Acute heel bruises can be easily treated using the P.R.I.C.E. principles – Protection, Rest, Icing, Compression, Elevation. Ice can be applied either through an ice bag or through cold water immersion (ice bucket). Ice should be applied for twenty minutes at a time every two hours for the first two to three days.  

To protect the injured heel, the athlete should not walk on the heel until the heel is pain free during weight-bearing.  can be used during the time that the heel is painful. The athlete should be non-weight bearing during the first day or two (depending the athlete’s pain) moving to partial weight-bearing as tolerated.

It is important for the athlete to not push through the pain in this type of injury. Practicing and playing with heel pain may place the athlete at risk for a more serious injury including damage to the outer lining of the bone (periosteum). Playing with heel pain could turn a short rehabilitation period into a long one.

Once the pain has subsided, the athlete may choose to resume activity with a heel cup and consider . Last, the athlete should ensure that his/her shoes have sufficient cushion to protect the heel when returning to sport or consider

Runners with heel pain should consider wearing their with most weightbearing activity until they are healed.  These shoes will continue to provide cushion and comfort during rehabilitation.

How to tape a bruised heel

The following video shares how to tape a bruised heel and the best technique to use.

Sports Injuries and When to See the Doctor

Hundreds of athletes sustain acute injuries everyday, which can be treated safely at home using the P.R.I.C.E. principle. But if there are signs or symptoms of a serious injury, emergency first aid should be provided while keeping the athlete calm and still until emergency service personnel arrive. Signs of an emergency situation when you should seek care and doctor treatment can include:

  • Bone or joint that is clearly deformed or broken
  • Severe swelling and/or pain,
  • Unsteady breathing or pulse
  • Disorientation or confusion
  • Paralysis, tingling, or numbness

In addition, an athlete should seek medical care if acute symptoms do not go away after rest and home treatment using the P.R.I.C.E principle.

When Can I Return to Play? 

The athlete can return to play when he/she has been released by his/her physician and is pain-free on weight-bearing with all activity. 

References

Anderson, M.K., Parr, G.P., & Hall, S.J. (2000). Foundations of Athletic Training: Prevention, Assessment, and Management. (4th Ed.). Lippincott Williams & Wilkins: Baltimore, MD.

Arnheim, D. & Prentice, W. (2009). Principles of Athletic Training. (10th Ed.). McGraw Hill: Boston, MA.

Bahr, R. & Maehlum, S. (2004). Clinical Guide to Sports Injuries. Human Kinetics: Champaign, IL.

Brukner, P. & Khan, K. (2002). Clinical Sports Medicine (2nd Ed.). McGraw Hill: Australia.

  • Cathy

    My son is a Slopestyle snowboarder, he knuckled a trick on a 40ft jump. His one heel is sore, he can still walk, but jumping, it’s still sore, and radiates from the heel to the ankle bone. He is travelling, so hard to see a Dr., my son believes it’s only bruised, so has been off of it for 2 days, but competes on big jumps tomorrow. What would you suggest?

  • Stephen Kitching

    I stepped on a sharp stone with my full weight, from a height of about half a meter, while wearing flip-flops, five months ago, my heel have been sensitive ever since, but the past two weeks I started experiencing great pain when putting weight on my heel. It is definitely getting worse, we only have general practitioners where I live, I don’t know what to do.

  • SportsMD

    Sorry to hear about your heel injury Stephen. What city and state are you close to? Maybe we can help find you a doctor. Try following the treatment options on this page and getting a good pair of sneakers or shoes and add cushion insoles.

  • Mahlan

    I have been playing soccer. I have planted my left foot into the ground to shoot with my right foot and felt pain go through my whole foot. I felt something similar to this during the winter while playing on turf for the first time. What can I do? This is the first time I’ve seen a bruise come with it.

  • Hussein Youssef

    I was jumping in a trampoline and landed heavily barerfoot on a hard surface with my heel iv been experiencing annoying pain ever since while practicing icant give 100 % what to do? by the way i put ice all the time but i need to practice as im preparing for the next season

    please answer

  • Charles Nocixel Clymans

    Similar experience to Stephen’s, I was on a roof and hopped down, maybe 7 feet, and landed with all my weight on my left heel. It hurt and I collapsed on top of it. For the past week I’ve been trying to stay off of it but I had to work construction (roofing) which involved a lot of jumping up and down ladders and roof sections. This article was helpful.

  • Vahan

    Thank you ? this helped me better understand what was going on. I was neglecting the fact that something was wrong until one day I was dunking nd the pain got to a ultimate boiling point.

  • Heidi Haney

    Mine’s from running. It’s so hard to STOP running while it heals. How long is this healing process??

  • Ciara Rodriguez

    ok im in a lot of pain in the heal part of my right foot. I jumped a six foot fence and when i landed i felt some tingly sensation on my right foot causing extreme pain. As i walked to my car, putting a lot of pressure on my injured foot, it caused more pain. To top it all off i had to drive home in my manual car. Every time i clutched to brake i would literally cry because of the pain. Is there any advice to what might of happened to my foot. Its my second day and still havent seen a doctor. Every time i walk it hurts even more. Someone please help.

    • Ciara Rodriguez

      I couldnt sleep last night because of the pain. The pain is now affecting my ankle and other leg because of the pressure im using to be able to walk. Even when my foot is elevated it still hurts. Any advice to what might be causing my pain and tingly sensation on my other leg. Note my other leg is fine.

  • Johannes Stromhaug

    I’m a high school pole vaulter, and I didn’t make it into the mat and i was on a 14’6″ pole so I fell about 7ft and landed on my heel on the track. I felt a lot of pain but I kept jumping and the next day I could hardly walk. Our trainer looked at it and said that I had a bruised heel, but it is fine to run on. But everywhere I look I’m advised to avoid even walking on it. I think I’ll see a specialist just to be sure…

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