A heel bruise, aka a stone bruise or a calcaneal fat pad contusion, is caused by excess force directed to the bottom of the heel.
How the heel fat pad works
This specialized fat pad works much like a mattress as it cushions normal heel strikes and prevents the calcaneus (heel bone) from getting directly injured. Common ways people bruise their heel include:
- Jumping and landing from a high place
- Running with a heel strike instead of forefoot landing (see our discussions on barefoot running)
- Stepping on a small stone
What happens during the injury
Heel bruising is caused by excessive force to the bottom of the heel. Depending on the energy of the injury the fat pad can be:
- Contused (minor bruise with bleeding into the tissue)
- Partially disrupted (split in half)
- Completely disrupted (torn away from the bottom of the heel bone)
In higher energy injury cases, the calcaneus bone itself can be fractured
How to treat Heel Bruises
Rest, Ice, Compression, and Elevation. Rest is the most important and the hardest to do. Foot problems are so prevalent in our society because we never give our feet a break. Professional athletes are some of the worst offenders at trying to return to activity too early.
What can go wrong
Returning to activity too quickly will not allow the fat pad to heal completely, resulting in a new bruise and resetting the healing process.
If excessive scarring forms, it can trap nerves that run through the bottom of the heel. These nerves don’t get better without release of the scar tissue. While surgery and the recovery are easy, making the diagnosis is quite challenging as it is almost always mistaken for Plantar Fasciitis. Skilled ankle and foot surgeons will spend the time necessary to make the distinction.
Lance Silverman, MD
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