Bruised Heel

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A bruised heel is an injury to the fat pat that protects the heel bone. It is also known as a policeman’s heel. An individual can get a bruised heel from the repeated force of his / her foot striking the ground, for example, if he / she runs or jumps consecutive times. It can also happen from a single injury, such as jumping from a big height onto the heel. Either way, the bruise may cause an amount of pain whenever you take a step.

A bruised heel can take 1-3 weeks to heal. If you have also bruised the heel bone, it may take up to 6 weeks for you to fully recover. A bruised heel can be associated with plantar fasciitis, a condition that most commonly affects a patient’s heel. Therefore, if you are affected by a bruised heel, you will feel pain in the sole of the foot, which is in the region of the heel. This pain is sometimes described as a sensation of stabbing. The pain tends to be particularly severe in the morning, when taking your first few steps after waking up, or in a more general way when you begin to use your feet after long periods of rest. It is therefore common for someone affected by the condition to experience pain when standing up after sitting for an extended period of time. Overall, this condition can become an annoyance for even day-to-day activities. The pain and stiffness of the foot may cause a patient to limp. The pain can also be noticeable if you stand up for a long period of time, or if you perform an intense physical activity, such as playing certain sports. The pain is not necessarily felt during the effort, but rather afterwards. In most cases, patients are only affected in one foot. However, it is possible for both feet to be involved.

Causes & Symptoms

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The main symptom of a bruised heel is pain at the bottom of your heel bone, also called the calcaneus. It will likely hurt when you either walk or press on the heel. If the bone is also bruised, the pain might feel sharp. You may also see a red or purple bruise on the outside of your heel. The bruise is from bleeding under the skin. The pain from a bruise usually is not as severe or as long lasting as pain from plantar fasciitis – this is inflammation of the thick band of tissue that runs from the bottom of your foot up to your heel bone. With plantar fasciitis, you will feel an intense or stabbing pain when you take a step. The pain will worsen in the morning when you first stand up and after you exercise.

Within our heel, there is a pad of fat that surrounds and protects the heel bone. Damage directly to this pad from excessive force to your foot can lead to a bruised heel. Sometimes, the heel bone can bruise, or the fat pad can tear.

 

Other causes of a bruised heel include:

 

  • Jumping or falling and landing awkwardly on the heel from a height.

 

  • A forceful blow to the heel, such as a kick.

 

  • Stepping or landing on a stone or a similar object causing a heel injury.

 

  • Walking or running with poor foot mechanics and poor shock absorption.

 

  • Walking or running on hard surfaces.

 

  • Repetitive forces on the heel such as jumping repeatedly.

 

  • A sudden increase in training, walking, or running.

 

  • Poor footwear.

 

Normally, there is no definitive underlying reason for a bruised heel, however, it is quite often associated with having a tight calf muscle. There are also certain other factors putting you at greater risk of developing the condition, such as extended periods of standing (hence the term “policeman’s heel”). Additionally, a sudden gain in body weight is strongly linked with the occurrence of a bruised heel.

Who Gets Bruised Heel?

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Anyone can experience a bruised heel, especially athletes who perform many sports activities such as soccer, basketball, football, athletics (especially triple jump), and tennis. Therefore, athletes who repetitively land from jumping may be at risk for a bruised heel. In addition, wearing shoes that are not cushioned well enough to support the feet, or even running barefooted (especially on hard surfaces), will increase the likelihood of developing a bruised heel. Athletes who perform difficult training sessions constantly, such as strength training, may have a higher chance of injuring the heel and thus causing a bruised heel. Other risk factors that are linked to experiencing a bruised heel are:

 

  • Heel fat pad atrophy
  • Being overweight / obese
  • Excess foot pronation or flat feet

 

Elders who are aged 65 and older are also at a high risk of experiencing a bruised heel due to the general wear and tear of the feet throughout the years.

How Does It Affect You? How Serious Is It?

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As mentioned earlier, the bruised heel may also lead to other major conditions such as plantar fasciitis and / or heel fat pad atrophy. In the heel, there is an atrophy at the thickness of the fat cushion; this can often be mistaken for plantar fasciitis, when there is actually a loss of shock absorbency of the heel on impact. Situated on the plantar aspect of the ball of the foot, there is fat pad atrophy, which commonly worsens as we age and is also present in various disease processes, such as autoimmune conditions. As for plantar fasciitis, it is one of the most common causes of pain located in the bottom of the heel and the foot arch. The plantar fascia is a thick, fibrous, ligament-like band on the bottom of the foot. It is attached to the heel, runs forward along the foot, and then attaches once again at the ball of the foot. When the plantar fascia becomes irritated and swollen, the condition is called plantar fasciitis. So generally, it is important to rest until your bruised heel is fully recovered. Going back to sports and other activities too soon can interrupt the healing process of a bruised heel. Eventually, you can develop scars in your heel that may require surgery in order to correct.

Reviewing other factors that may place an athlete at risk for a bruised heel is a good place to start to prevent a heel injury. Because shoes with poor shock absorption can place an athlete at risk for a bruised heel, careful selection of shoes should always be a priority for athletes, especially in sports that require a lot of running, jumping, and / or quick changes of direction. Runners should replace their shoes often, so as to ensure that the quality of the shock absorption components of the shoe is still well effected and able to prevent any symptoms linked to a bruised heel. Athletes and other patients should research shoe designs and purchase shoes that are specifically designed for their desired sports activity, and for their feet in general. Anyone who commonly plays any sports activity should also take care to wear shoes when training, especially when training on uneven surfaces, such as the beach – some may mistakenly believe that the soft surface on the sand may prevent injuries to the foot, however, the outcome of running on sand may be the opposite. Along with sustaining heel injuries from running barefooted on the beach; uneven surfaces can also cause injury to the muscles on the inside and / or outside of the ankle.

Recommended Treatment

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A patient might not need to see a doctor for a diagnosis involving a bruised heel. This is because a bruised heel is often treatable at home. However, if your heel pain does not improve with self-care measures, it is recommended to make an appointment with a foot specialist, known as a podiatrist. He or she will first examine your foot and ankle. Then you may need an X-ray to check if your heel bone is broken. Your doctor might also check your gait or the way you walk to look for any issues that might have caused a bruised heel.

After diagnosis, generally, the right treatments aim to reduce the pain and swelling and prevent any further injury. Acute heel bruises can be well treated using the P.R.I.C.E method (protection, rest, icing, compression, and elevation). Ice can be applied either through an ice bag or through cold water immersion, such as an ice bucket. Ice should be applied for 20 minutes at a time every two hours for the first 2-3 days.

Most problems that cause a bruised heel get better over time with nonsurgical treatments. Therapies focus on easing pain and inflammation, improving foot flexibility, and minimizing stress and strain on the heel. These types of treatments include:

 

  • Pain relievers – Non-steroidal anti-inflammatory drugs (NSAIDs), combined with ice packs to help ease pain and swelling.

 

  • Injections – Steroid injections can ease pain and swelling. Steroid injections should be given rarely, if ever, for a tendon problem but may help for plantar fasciitis, bursitis, and a severely bruised heel.

 

  • Orthotic devices – Over-the-counter or custom-made shoe inserts can take pressure off the heel; some people find relief by wearing a splint at night, especially if they get morning foot pain. A walking boot brace may be necessary for more severe symptoms. You may also need to switch to more supportive shoes for everyday wear and exercise.

 

  • Physiotherapy – Massage, physiotherapy, and ultrasound therapy can break up soft tissue adhesions. These treatments may reduce pain and inflammation.

 

  • Stretching exercises – A healthcare provider can show you how to perform heel stretching exercises for tight tendons and muscles.

 

  • Taping – You can use athletic or medical tape to support the foot arch or heel.

 

Studies show that both strengthening and stretching exercise sessions, including stretching the Achilles’ tendon, can significantly reduce pain and improve walking in people with a bruised heel. Here are three popular types of exercise methods you can perform at home or elsewhere:

 

Plantar Fascia Massage

 

First you must sit in a chair or stand with one foot resting on a small ball or frozen water bottle. A frozen water bottle is useful as the ice helps reduce inflammation. Gently roll the ball or water bottle forward and backward under your foot – then you start at just below the ball of your foot and end just before your heel. Finally, roll the ball or bottle back and forth slowly 10 times for each foot. After finishing the first set, repeat two more sets per foot. It is recommended to perform this exercise once a day.

 

Heel Raise

 

Firstly, stand with the balls of your feet at the edge of a bottom step. With your heels hanging off the edge, slowly and gently lower your heels just below the edge of the step. You may feel a stretch in your calf muscle. Lastly, slowly rise onto the balls of your feet. Repeat this method 10 more times, then rest afterwards. Complete two more sets of this session. It is also recommended to perform this exercise once a day.

 

Sitting Ankle Inversion

 

Sit upright on the floor with your legs straight out in front of you. Make sure to avoid any hip movement whilst performing this exercise. Place your left leg over your right leg with a resistance band secured around your upper foot and looped around the bottom of your lower foot. Hold the end of the band in your hand. Slowly move your upper foot away from the lower foot. To do this, rotate your ankle inwards and slowly return it to the starting position. Finally, repeat this 10 more times and complete two more sets per foot.

Alternative & Homeopathic Treatment

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Many conditions can be relieved by applying either cold or heat packs and compression to lessen any symptoms. Here are a few at-home remedies to try:

 

  • Cold compression – Apply a cold compress to the injured area for 10-20 minutes at a time to help ease the pain. This also reduces inflammation and swelling, which may speed healing time and make it easier to move.

 

  • Heat pack – A few days after the injury, try applying heat to the area. Some patients prefer to alternate heat and ice packs.

 

  • Heel elevation – It is recommended to sleep with the foot above the level of the heart and during the day, elevate it as often as possible. This can help reduce swelling and pain.

 

  • Rest – Avoid any strenuous activity for the first few days as the bruised heel can also destabilize the foot, increasing the risk of other injuries.