With every step you take, the whole weight of your body presses on your heels. It is not surprising that this may lead to heel problems, like a bruised heel. Although bruised heels are rarely serious, they can cause a significant amount of pain, especially when walking. Knowing more about this condition will help you recognize the symptoms and learn how to treat it.
It's All About the Heel Pad
Beneath the heel bone — called the calcaneus — sits the heel pad. This soft area contains mostly fat. It acts as a shock-absorbing cushion, protecting the calcaneus as you walk. When the heel pad becomes damaged, tiny blood vessels can break, forming a bruise. This produces a bruised heel, also known as a heel pad contusion or heel pad syndrome.
At times the heel pad is injured by walking on a stone or similar object that causes sudden bruising. When this occurs, the condition may be called a stone bruise. More commonly, the heel pad is damaged gradually by the heel repeatedly striking the ground during daily activities. Repeated damage can cause chronic inflammation and thinning of the heel pad, which makes it even more susceptible to further damage.
Jumping Sports and Other Factors Increase Your Risk
Repeated force on the bottom of your heels increases your risk of developing a bruised heel. This may occur if you walk long distances for long periods on a daily basis. For this reason, yet another name for a bruised heel is "policeman's heel."
Sports activities that involve repeated forceful impact on the heel also increase your risk. Long jumpers, high jumpers, basketball or tennis players and long distance runners or power walkers are particularly susceptible. Being overweight causes more weight to land on your heels, increasing the possibility of a bruised heel.
The heel pad may become thinner as part of the natural aging process, placing older people at increased risk of a bruised heel. Walking around with bare feet increases the chances of stepping on a stone or other object, producing a sudden bruised heel.
Heel Pain Is Expected
A bruised heel typically causes pain deep within the middle of the heel. The pain improves with rest, so it is often better in the morning but worsens as the day goes on. Standing and walking will make the pain worse.
If you are uncertain whether you have a bruised heel, take the painful foot in your hands and press gently on the middle of your heel with the pads of your thumbs. Increase the pressure steadily until you feel pain. If the pain is sharp and then decreases when you release the heel, you may have a bruised heel. Pain from a bruised heel can last for weeks.
Because the bruise occurs deep within the heel pad, you usually will not be able to see it. Sometimes the heel pad becomes swollen, but this is uncommon.
Other Conditions May Cause Similar Symptoms
A bruised heel is sometimes confused with plantar fasciitis — inflammation of the fibrous tissue located between the heel and ball of the foot. But in plantar fasciitis, the pain is typically located at the front of the heel and extends along the sole of the foot towards the toes. It is also usually worse in the morning and improves during the day.
Fractures of the calcaneus can cause pain similar to a bruised heel, but the pain will be more severe and continue until the bone heals. Tiny breaks in the surface of the calcaneus can occur with repeated force on the heel if the heel pad becomes so thin that it no longer acts as an effective cushion. An acute injury, such as landing on the heel during a fall, can cause a true fracture. This is most common in older adults whose bones have been weakened by osteoporosis.
Treatment Relies on Rest
Resting your heel by limiting your walking is an important way to treat a bruised heel. Sports activities that involve forceful landing on the heel should be avoided until symptoms disappear.
Substituting activities like swimming can help maintain fitness when other activities are restricted. Applying ice or a warm compress and taking over-the-counter anti-inflammatory medications such as ibuprofen (Advil, Motrin) or naproxen (Aleve) can be useful. Taping the heel and wearing heel inserts or footwear with good support are other ways to treat a bruised heel.