Bruised Heel

Bruised heel

A bruised heel is also known as a fat pad contusion or Policeman’s Heel. It is a common cause of pain under the heel. Here we explain the symptoms, causes and treatment of a bruised heel.

Medically reviewed by Dr. Chaminda Goonetilleke, 4th Jan. 2022

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Bruised heel symptoms

Heel pain

Symptoms of a bruised heel consist of:

  • Pain under the heel bone (Calcaneus).
  • Symptoms usually come on gradually over time but can be brought on instantly from landing badly on your heels.
  • You will find walking or running will be uncomfortable or painful. However, running on your toes or the balls of your feet will not be painful.
  • Pressing in under the heel may trigger pain or be uncomfortable.

Walking or running will make your symptoms worse, whilst complete rest from aggravating activities reduces pain. Often athletes will put up with mild symptoms for some time before pain prevents them from training.

Injuries with similar symptoms:

When diagnosing a bruised heel it is important to consider other injuries which have similar symptoms.

Is it Bruised heel or Plantar fasciitis?

Bruised heel symptoms are similar to those of plantar fasciitis. However, the main differences are:

  • A bruised heel is not usually worse first thing in the morning, Plantar fasciitis is.
  • Pain is unlikely to radiate forwards into the arch of the foot, unlike plantar fasciitis.
  • A bruised heel often improves with short-term rest and gets gradually worse with walking.
  • But plantar fasciitis is often worse after rest/overnight and improves with walking.
bruised heel symptom checklist

What is a bruised heel?

A bruised heel is a contusion of the tissues and bone under the heel.

Anatomy

Bruised heel bone

The heel bone, (calcaneus) is protected by a pad of fatty tissue. This is composed of an elastic 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.

Repetitive impact to your heel causes the fat pad to flatten and be displaced sideways. As a result, this leaves a thinner protective layer, resulting in bruising to the heel bone.

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Causes

A bruised heel is usually caused by overuse. In particular, with activities such as repetitive jumping, long-distance running, walking, or landing heavily on your heels.

Although overuse is primarily the cause, there are a number of factors that may contribute:

Poor footwear

Poor footwear

If you wear hard, flat shoes with little or no cushioning, this increases the chance of overuse injuries. Make sure you have appropriate footwear which is in good condition.

Most running shoes are good for 400 miles before the midsole begins to lose its cushioning.

Training errors

Running too far too soon. Increase your running mileage by no more than 10% per week.

If you switch running surface or change your footwear then you may need to adjust/reduce your training until you adapt.

Bruised heel treatment

If you catch a bruised heel early then it should recover quite quickly, usually within a few days.

However, if you ignore the early signs of pain then it can be very difficult to treat. This is due to the fat pad becoming damaged beyond easy repair.

Rest

Rest until you have no pain. This is the most important because continuing to walk or run will not allow your foot to heal. Rest means complete rest.

Switch to cycling, swimming, or any non-weight bearing activity.

There is no point stopping running for a week if you put up scaffolding for a living.

If you have to be on your feet, then there are a few things you can do which will help:

Insoles & heel pads

heel pads

Wear a shock-absorbing/cushioning heel pad or insole in your shoes. This is especially important if you have to wear hard, flat, ‘sensible’ shoes to work.

Insoles or heel pads should be worn in both shoes to avoid leg length differences. This is likely to lead to further injury to the hips and lower back.

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Taping

Tape your heel. A simple heel taping technique will compress the fat pad and provide increased cushioning and protection.

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Zinc oxide sports tape

Footwear

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 your healing time.

Replace running shoes if they are old. Most are only good for 500 miles or 6 months of use.

Prevention is always the best cure so acting early with a fat pad contusion and resting is most important.

Professional Treatment

A sports injury professional will confirm the diagnosis and help identify any possible causes.

For example, if you have biomechanical problems such as overpronation or oversupination. Your therapist may do a gait analysis to assess how the foot moves during walking and running.

They will advise on insoles, orthotics, or heel pads to protect the fat pad in the heel.

However, for a bruised heel, gait is not normally a contributing factor.

References

  • Spears IR, Miller-Young JE, Sharma J, et al. The potential influence of the heel counter on internal stress during static standing: a combined finite element and positional MRI investigation. J Biomech 2007;40(12):2774–80.

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