Heel Pain / Bruised Heel

Heel pain can be caused by a variety of problems. It may be due to a traumatic injury, such as landing on the heel on a hard surface, or may be an overuse injury, such as plantar fasciitis. Here are the most common causes of heel pain:

• Plantar fasciitis - Inflammation of the plantar fascia which forms the arch of the foot
• Bruised heel (fat pad contusion) - Often caused by repetitive pounding on the heel
• Calcaneal fracture - A fracture of the heel bone, either caused by a direct trauma, or repetitive pounding resulting in a stress fracture
• Calcaneal bursitis - Inflammation of the sack of fluid which sits under the heel
• Tarsal tunnel syndrome - Entrapment of the plantar nerves as they pass round the outer ankle. Causes pain to radiate into the heel and arch of the foot
• Heel spur - A heel spur is a growth of bone under the heel which can (but doesn't always) cause pain. This may also be the cause of plantar fasciitis.

What is a bruised heel?

A bruised heel can be caused by either a sudden impact (such as landing heavily) or repetitive pounding. The heel bone (calcaneus) is protected by a pad of fat. Repeated pounding of the heel can cause the fat pad to be pushed up the side of the heel leaving less of a protective layer causing heel pain. This injury is also sometimes known as Policeman's heel. It is common in sports requiring a lot of impact onto the heel and in particular soldiers marching up and down on the parade square.

What can the athlete do about heel pain?

• Rest until there is no more heel pain
• Pad the heel of shoes with a shock absorbing insole or heel pad
• Replace running shoes if they are old (more than 400 miles of running) or the soles are weakened through use

Treatment

• A sports injury professional will confirm the diagnosis
• Advise on insoles (orthotics) or heel pads to protect the fat pad in the heel
• Tape the heel to provide pain relief and compress the soft tissue under the heel giving more protection to the bone

How long will it take to recover?

If you catch heel pain early and rest then it should recover quite quickly - within a few days. If you ignore the first onset of pain and the fat pad gets damaged beyond easy repair then this is a very difficult injury to treat. Rest means rest. There is no point you stopping running for a week if you put up scaffolding for a living and are on your feet every day. If you have to be on your feet then ensure you put a shock absorbing and cushioning heel insert into your shoes.

Related external links:

• NHS Video - Causes & treatment of heel pain