Bruised Heel (Fat Pad Contusion)

What Are Bruised Heels

The largest bone in the foot is the heel bone. Physicians refer to this bone by its Latin name, the calcaneus. Of all the bones in the foot, it is the calcaneus that bears the most of our weight when we are standing, walking, jumping, and running. For this reason, it is more prone to injuries than other bones in the foot. The word contusion simply means a bruise. However, in the case of heel bruises, the underlying injury may be a flesh bruise, a bone bruise, or either one of these accompanied by a fracture of the calcaneus itself.

The absolute most common type of foot injury due to athletics is a sprain of the ankle, but heel bruises are also common and can be very painful. They can also lead to difficulties engaging in physical activities as well as the normal tasks required in daily life.

Symptoms of a Bruised Heel or Foot Pad Contusion

There is a wide range of injuries associated with the heel. Damage to the heel bone or the fat pad covering it can vary from a mild bruise of the fat pad only, which will cause no lasting damage, to a severe fracture of the bone itself. In between these extremes it is possible to have a bone bruise or stress fracture of the calcaneus, both of which are regarded as moderately serious conditions . 
Common symptoms of heel bruises include all of the following:

  • Swelling in the heel area
  • Swelling around the heel area
  • Pain while walking, running, or jumping
  • Pain while standing still
  • A sensation of tenderness in the heel area, especially when it is subjected to pressure. This may be true even when the pressure is mild -- for example, when a patient presses against the heel area using his or her fingers.

bruised heelsA more serious symptom is possible displacement of the fat pad covering the heel bone, meaning that the pad itself can shift to one side or the other, leaving part of the heel bone without its usual cushioning protection. If this has happened, there will be a flattened spot on the heel. Comparing the injured foot to the uninjured one will make this flat spot an obvious anomaly.

Men or women who continue to engage in vigorous exercise despite the warning signs listed above might develop another symptom, one which is much more serious. Inflammation may set into the outside perimeter of the calcaneus. This area is referred to as the periosteum. Once inflammation has set in, it may become a chronic condition. At this point, the athlete has developed a debilitating injury.

What Causes a Bruised Heel or Foot Pad Contusion?

Heel bruises may result from either a series of repetitive small injuries or one single severe event. In moderate cases the injury will be restricted to the fat pad alone or to a bruise on the surface of the heel bone, but serious cases can involve a true fracture of the bone itself or even several fractures at once.
There are two main causes of heel bruises:

  • Repetitive motions.

These layer strain onto the heel and over time can cause injury. The phrase "repetitive stress injury" is apt in the case of foot pad contusions. Repetitive motions that can cause heel bruises include running or walking long distances at a single stretch. Marathon runners frequently develop one variety or another of the condition.

  • Sudden strong impacts.

In many cases, the sudden impact is associated with landing too hard on one's feet, especially onto a hard surface. Athletes engaged in jumping events are at risk for developing heel bruises. Anyone who lands on their heels from a significant height, such as from up on a ladder, is also at risk.

A more extreme example of this type of causation is associated with sky diving, a thrill sport that entails many serious risks of injury to a variety of bodily systems. In the case of the calcaneus or heel bone, a difficult landing during sky diving can cause it to shatter in several places at once. This would produce immediate severe pain as well as swelling and would require an extended convalescence during which walking would be ill advised if not impossible. However, a permanent deformation of the bone is not likely to result.

Within the two main causes listed above, there are some associated and related causes:

  • Lack of adequate footwear for the physical activity undertaken.

The classic example of this when it comes to heel bruises is participation in the military. Hours spent marching can lead to repetitive stress injuries, particularly when the shoes or boots worn do not have sufficient padding or other shock absorbing features. A general rule of thumb is that the harder the surface upon which an athlete or soldier will be running or marching, the more important it is to have shoes that provide shock absorption in order to shield the heel from excessive stress and strain.

  • Being overweight

Excessive weight strains all body systems and places additional stress on weight bearing bones such as the calcaneus, making them more vulnerable to injury.

  • Age

As we get older, our bones become more brittle, particularly if we are not getting enough calcium or the calcium is not adequately absorbed.

  • Going barefoot

This is particularly ill advised during athletic activities. Wear shoes that are well cushioned and when they begin to wear out, replace them. You can tell that shoes are beginning to wear out not only from their visual appearance but also from the feel of your foot inside them when you exercise. If you begin to suspect there is less cushioning now than previously, you are probably right.

  • Training surfaces that are uneven

These can produce sudden shocks of stress to the foot, which is adapted to generally expect a level surface to walk or run upon. Think of how difficult it is to walk in sand, which constantly shifts its surface characteristics, and you will have a sense of how uneven surfaces can lead to foot strain. Hard surfaces are also a problem, although in some sporting activities such as standard tennis, they cannot be avoided.

  • Sudden changes of direction

These can subject the foot to unexpected stresses for which the muscles and fat pad aren't prepared to compensate.

Diagnosis of Heel Bruises or Fat Pad Contusions

Most doctors can diagnose a heel bruise, but you may be referred to a sports medicine specialist for treatment. Visual inspection along with a thorough medical questionnaire and interview to ascertain your health history is usually sufficient to diagnose a simple bruise.

In cases where the sports medicine specialist has cause to suspect that a fracture may be involved, a bone scan or x-ray may be ordered. X-rays are considered a definitive test when it comes to diagnosing a heel bruise that also encompasses a fracture. More advanced diagnostic tests such as magnetic resonance imaging are usually not required.

Common Treatment Options for Heel Bruises or Fat Pad Contusions

Initial treatment will consist of measures designed to decrease swelling and alleviate pain. These measures will sound familiar to anyone who has had a sprained ankle or indeed, any kind of bone injury to areas of the foot. They include common procedures outlines in any first aid manual:

  • Ice (and later on, heat)
  • Elevation
  • Rest

Experts recommend that icing take place for no longer than twenty minutes at a time in order to avoid causing cold injuries to the flesh surrounding the heel bruise. Applying ice for this span of time every two or three hours is usually sufficient to reduce swelling and assist with the patient's pain level. It is common to continue ice treatment for two or three days.

Ice treatment may involve the direct application of an ice bag or ice gel pack (stored in the freezer to cause it to chill). Another method is to immerse the foot in water into which several ice cubes have been placed.

Rest involves encouraging the injured party to avoid all use of the heel. This includes walking as well as athletic activities. If walking absolutely cannot be avoided, then it is acceptable to utilize crutches; the goal is to keep all weight off the injured heel. This phase of treatment should continue until the patient can place weight on the heel without experiencing pain. In this case, pain is the body's warning system, letting the patient know that more healing needs to occur and that rest, therefore, should be continued.

When the patient or athlete first begins to put weight on the heel, even if the process is pain free, he or she should adopt a gradual approach. Do not jump right back into all your previous activities, but go slowly so that your heel bones can adjust back to full usage over time.

An interesting twist to the treatment regimen is that after two or three days of ice treatment, the patient should be switched to a heat treatment. This should continue for another two or three days. Heat may be applied directly using an electrical heating pad or even an electric blanket for those who do not have a pad and may not wish to invest in one. An even more inexpensive alternative is to plunge the foot into heated water. Be sure that the heel area is completely immersed and that the water is not hot enough to burn.

A Word About Pain

Unfortunately, athletes in particular are sometimes encouraged to ignore pain and keep working out despite it. This is extremely ill advised in many types of injuries, including heel bruises. Exercising or engaging in sporting activities when the heel is in a painful state can lead to a host of other injuries, some of which are quite serious, so do let yourself heal. If not, you may find yourself in a position where you have developed a severe condition and have no alternative but to face a much longer convalescence than you would have had initially.
A full return to sports activities should not take place until a physician has authorized it.

Ongoing Treatment Options

When the patient is ready to resume normal activities, it may be advisable to use some protective devices that are designed to shift weight away from the center of the heel. This will allow for standing, walking, and running with less stress being placed on the heel bone itself, as well as the fat pad covering and cushioning it. The two most common such devices are:

  • The protective donut
  • The heel cup

The patient should also make sure that footwear is well cushioned and appropriate to the activity being undertaken. All of the other caveats discussed above also apply. Patients should avoid hard or uneven surfaces when possible and make efforts to lose weight.

Prevention of Heel Bruises

The single most important step you can take to prevent heel bruises is to wear proper shoes. They should be sized correctly for your feet and include enough cushioning and padding so that you can comfortably complete your tasks and / or sporting activities. For some sports, special shoes are available; these are designed specifically with that sport in mind. Avid athletes would be wise to invest in such shoes; even dabblers will often find them of great benefit. In the absence of sport specific shoes, a general purpose running shoe is appropriate for most sporting activities.

Another important consideration in prevention is the fact that shoes should be replaced frequently to avoid repetitive stress injuries. Runners in particular should be vigilant to be sure that their current shoes still have all the shock absorption qualities now that they had when new. If not, purchase new.
Other basic prevention measures include taking part in only those sporting activities that are appropriate for your age and physical condition, and losing weight.


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