A bruised heel or fat pad contusion is also known as Policeman's Heel and is a common cause of pain under the heel. It is usually caused by overuse, resulting in damage to the soft tissues or bone under the heel, but can also occur suddenly from a heavy landing or impact. Here we explain the causes and treatment, including taping, to help you recover in the shortest possible time.
On this page:
- Symptoms & diagnosis
- Causes & anatomy
Bruised heel symptoms
Symptoms of a bruised heel consist of pain under the heel bone (Calcaneus) which usually comes on gradually, although it can be brought on instantly from jumping onto the heels from a height. Walking or running will be uncomfortable or painful, however running on the toes or balls of the feet will not be painful.
The athlete may put up with mild symptoms for some time before it becomes so bad it prevents them from training. Pressing in under the heel may trigger pain or be uncomfortable. Walking or running will make symptoms worse, whilst complete rest from aggrevating activities reduces pain.
Bruised Heel vs Plantar Fasciitis
Symptoms of a bruised heel bone are 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 pain is unlikely to radiate forwards into the arch of the foot as plantar fasciitis can. Another key difference between a bruised heel and plantar fasciitis is that a bruised heel often improves with rest and gets gradually worse with walking, whilst plantar fasciitis is often worse first thing in the morning and improves with walking (up to a point) as the tissues warm up and stretch.
Causes and Anatomy
A bruised heel is usually caused by overuse such as repetitive bounding, long distance running, walking or landing heavily on the heel. Wearing hard, flat shoes which provide little or no cushioning to the heel bone can increase the likelihood of sustaining this injury. 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.
The heel bone, or calcaneus bone as it is called, is protected by a pad of fatty tissue. This is composed of an elsatic fibrous tissue septa (latin for something that encloses) separating closely packed fat cells. The fat pad acts as a shock absorber for the heel protecting the calcaneus or heel bone.
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.
Bruised heel treatment
If you catch a bruised heel early and rest then it should recover quite quickly, usually within a few days. However, if the first onset of pain is ignored and the fat pad gets damaged beyond easy repair then this is a very stubborn and difficult injury to treat.
What can the athlete do? Rest! 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. Rest means complete rest. There is no point stopping running for a week if you put up scaffolding for a living and are on your feet every day. Switch to cycling, swimming or any nonweight bearing activity.
If you have to be on your feet then there are a few things you can do which will reduce load in the injured foot:
- Wear a shock-absorbing/cushioning heel pad or insole in your shoes. This is especially important if you have to wear a hard, flat, 'sensible' shoes to work. Insoles or heel pads should be worn in both shoes, even if only one heel is bruised, as raising the heel on one side will cause a leg length difference which can cause other injuries to the hips and lower back.
- Tape the heel. A simple roll of 2.5cm non-stretch zinc oxide tape applied correctly can compress the tissues under the foot providing additional protection whilst healing takes place (see below).
- Wear soft trainers with lots of cushioning in the midsole. They may not look good in the office but will make a big difference to the healing time.
- Replace running shoes if they are old. A running shoe is designed to last for around 400 miles of running after which the midsoles are weakened through use. Read more on choosing running shoes.
Prevention is always the best cure so acting early with a fat pad contusion and resting is most important.
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. They may do a gait analysis where they assess how the foot moves during walking and running, although the causes of a bruised heel are usually fairly obvious and gait is not usually a contributing factor.
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.
Bruised Heel Taping
The aim of taping for a bruised heel is to compress the soft tissue under the heel increasing the natural cushioning of the foot and protect the heel from impact. 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 nonstretch 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.