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Treatment includes rest and protecting the area with padding or taping as well as identifying potential causes and rectifying them.
Symptoms consist of pain under the heel bone which usually comes on gradually, although can result instantly from jumping onto the heels from a height. Walking will be uncomfortable or painful. The athlete may put up with mild symptoms for some time before it becomes so bad it prevents training.
Pressing in directly under the heel may trigger pain. Symptoms can be similar to those of plantar fasciitis, another common cause of heel pain, however a bruised heel is not usually worse first thing in the morning and doesn't usualy radiate forwards into the arch of the foot like plantar fasciitis can. Pain often improves with rest alone.
If you catch heel pain early and rest then it should recover quite quickly within a few days. If the first onset of pain is ignored and the fat pad gets damaged beyond easy repair then this is a very difficult injury to treat.
Self help treatment
Rest until there is no more pain. This is the most important element of treatment as continuing to walk or run on the injured foot will not allow the injury to heal. If you have to be on your feet then ensure you put a shock absorbing and cushioning heel pad into your shoes and tape the heel for additional protection.
Rest means rest and 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. Wear soft trainers with lots of cushioning or pad the heel of shoes with shock absorbing insoles or heel pads. These should be worn in both shoes, even if only one heel is bruised. Wearing a raise in only one shoe causes a leg length difference which can cause other problems.
Replace running shoes if they are old. A running shoe is designed to last for around 400 miles of running after which the mid soles are weakened through use. Read more on choosing running shoes.
A sports injury professional will confirm the diagnosis and help identify any possible causes such as errors in training or biomechanical problems of the foot through gait analysis. They can advise on insoles, orthotics or heel pads to protect the fat pad in the heel and correct any biomechanical problems of the foot. They may tape the heel to provide additional protection and support whilst healing.
Taping the heel can provide pain relief by compressing the soft tissue under the heel giving more protection to the bone. A simple roll of 2.5cm / 1 inch non stretch zinc oxide tape is all that is needed. Place an anchor strip horizontally around the back of the heel. Then place a support strip under the heel. Then repeat the first anchor strip over the top. Continue alternating support strips and anchor strips until most of the heel is covered.
Watch expert interview video on heel pain from sports podiatrist Ian Sadler.
Causes and prevention
A bruised heel is usually caused by overuse such as repetitive bounding, long distance running or landing heavily on the heel. The heel bone or calcaneus bone as it is called is protected by a pad of fatty tissue. Repeated pounding of the heel can cause the fat pad to flatten and be displaced up the side of the heel leaving a thinner protective layer which may result in bruising of the bone and pain.
It is common in long distance runners, soldiers during training from constant marching and sports involving a lot of jumping and landing on the feet.
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