Bruised heel bone or something more serious?

The Anatomy of the foot

The foot plays a pivotal role in your life, whether you are a world-class athlete, a weekend warrior, or your daily exercise consists of a few trips to the kitchen. The daily stress on the foot can take its toll: from a bruised heel bone to heel pain after running due to overuse or impact injuries. When your heel or even your whole foot is sore, your activities are limited. You need effective, reliable, fast-acting treatment options.

The human foot has 33 joints, 26 bones, and more than 100 tendons, muscles, and ligaments holding everything together. As an overall structure, it must be both flexible and rigid. It rivals some of the best architectural designs in the world. The calcaneus or heel bone is the largest of the foot bones. Just above the calcaneus is the talus. These two bones make up the hindfoot. The talus is also connected to the bones of the lower leg and make up the ankle joint. Together these bones provide the flexibility and stability needed to walk and run.

Foot biomechanics

Whether walking or running, the foot absorbs the stress of the body weight, accommodates the bumps and irregularities of the walking surface, and supports and stabilizes the body in an upright position. With each step, the load from the body’s weight on the talus is transmitted to the heel bone.

When running, the posterior, outside border of the foot, initially contacts the ground. In a study of 753 distance runners, 80% landed on the hindfoot with each step and 20% on the midfoot. When walking, the vertical force on the heel is less than 120% of body weight. Whereas, while running the vertical force approaches 275% of body weight. These forces can lead to a sore foot or heel. Constant pounding on the heel due to malalignment or a poor gait pattern can cause pain after running due to bruising, bone spurs, or ligament injuries.

Causes: Is your heel pain due to a bruised heel bone or a stress fracture from overuse?

Heel pain accounts for 10% of all athletic injuries. In the U.S, heel pain leads to one million physician visits each year at the cost of $284 million. Many of these visits are for heel pain after running or a bruised heel that sidelines participants from the sports they love. The cause of heel pain is sometimes elusive and can include the following possibilities:

Foot-level factors

A pronated foot type (your foot rolls inward), a limited ability to dorsiflex or pull the foot upwards towards the shin, and reduced muscle strength can put a strain on the mechanical function of the foot. This strain can lead to abnormal gait and injuries. Unbalanced forces on the ligaments of the foot can lead to pain or soreness after running.

Bruised heel bone

Stepping off a curb unexpectedly or accidentally stepping on a pebble or a rock can bruise the fat pad covering the heel bone. Overuse injuries and shoes without adequate padding can also injure the heel’s fat pad. You may or may not see bruising.

Bursitis

A bursa is a sac of fluid that acts as a cushion at the joints. When these sacs become inflamed from repeated pressure on a limited area or overuse due to repetitive exercises, pain, swelling, and stiffness are common. Awkwardly landing when running or wearing ill-fitting shoes can inflame the bursa on the back of the heel. Pain may be felt deep into the heel bone.

Stress fractures can cause pain with running or walking

Strenuous exercise or a sudden increase in training can cause stress fractures. Stress factors are tiny cracks in the bone that develop as a result of a single blow or repetitive stresses on the bone leading to heel impact injuries.

Stress fractures make it difficult to put any weight on the affected bone and are a common cause of pain after distance running. The pain tends to get worse if exercise continues and improves some with rest. Swelling and redness are usually present. The pain can typically be localized to a single point on the bone. The ability to localize the pain differentiates pain from a stress fracture from a bruised heel bone.

Nerve pain

The compression of a branch of the lateral plantar nerve can cause pain, numbness, and tingling in the heel area. A sprain, a broken bone, or a swollen vein can lead to nerve compression. Nerve pain is usually unilateral.

Diagnosis

To diagnose the cause of your heel pain correctly your health care provider may need the following information:

• What makes your pain better or worse?
• Is the pain localized to the heel, or is your whole foot sore?
• Have you had any recent injuries leading to a bruised heel bone?
• Do you participate in any sporting activities?
• Do you have pain after running?
• Have there been any recent changes in your physical activity level?
• Do you have any medical conditions such as diabetes or arthritis?
• What shoes do you wear regularly? Have you recently changed shoes? Do they fit well? Do you notice any abnormal wear patterns on the sole of the shoe?

Treatment: Heel pain

Treatment: Heel pain due to bruising

According to the American Academy of Orthopedic Surgeons, the following initial steps may help relieve heel pain:

Ice: Icing the heel throughout the day can relieve pain and decrease inflammation and swelling. Ice constricts the blood vessels and is an effective treatment for reducing bruising of the heel bone. Ice for 20 minutes and stop when the skin becomes numb.

Heel pain due to impact injury or overuse

Rest: Stop the activities that make the pain worse. Vary your exercise routine. Consider switching from high-impact to low-impact exercises. Cross-training with exercises such as biking, using an elliptical, and swimming will keep you active and help stretch the calf muscles.

Non-steroidal anti-inflammatory medications: A temporary use of ibuprofen or naproxen can be an effective treatment to reduce swelling and pain due to heel bruising. If pain persists, seek medical advice.

Exercise: Stretching the calf muscles by pushing off a wall or by allowing the heel to drop below the level of the foot when on a stair tread can stretch the calf muscles and relieve tension on the Achilles tendon. This stretch decreases the tension of the Achilles ligaments on the heel easing the pain of a sore foot.

Heel pain due to foot misalignment

Inserts and orthotics: Supportive shoes, inserts, and specially designed orthotics can reduce pain and stabilize the foot. Cushioning the heel can reduce the pounding force on the fat pad with each step to allow tissue healing.

Prescription options

In addition to these home remedies, prescription medication can speed up healing and get you back to your everyday activities, whether your pain is from a single impact injury or heel pain after running long distances.

Summary: Heel pain

There are many causes of foot pain from a bruised heel bone to pain after running injuries due to impact or overuse injuries. Many injuries will improve with rest and stretching exercises. While the treatment options listed in this article may help resolve a sore heel due to bruising, there is no substitute for a thorough medical evaluation and diagnosis.

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Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider.  You should always consult a practicing professional who can diagnose your specific case.  The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice. 

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