Heel Contusion – Heel Bruise

A heel contusion or heel bruise can be a painful injury. It is caused by a fall, or a direct blow to the heel. It results in injury to the soft-tissue on the weight-bearing surface of the heel. A heel contusion makes weight-bearing difficult and patients will often limp or walk on their forefoot to offload the heel area. It may be necessary to rule out a heel bone (calcaneus) fracture which is an even more serious injury. To do this an x-ray is required. Most heel contusions will heal well with time and appropriate rehabilitation. However, residual heel pain can occur after recovery from this injury.

Clinical Presentation

A heel contusion, or heel bruise is a relatively common injury. It typically occurs following a fall from a height or a direct blow to the heel. This result in pain, swelling, and bruising around the heel. Patient will often limp when they walk. They will usually attempt to offload their heel by loading mostly through their forefoot. A bad heel contusion can make jumping off the affected foot difficult or impossible for an extended period of time after the injury.

A heel contusion results in soft tissue injury with bruising to the tissue around the heel. Bone bruising to the heel bone (calcaneus) can also occur.

If the force is great enough, in addition to a heel contusion the heel bone may fracture (calcaneus fracture). A calcaneal fracture is a debilitating injury which may require surgery and takes months to recover from. However, even without a fracture of the heel/calcaneus bone a heel contusion can be a frustrating injury with a prolonged recovery time.

Clinical Examination

Patients who have suffered a heel contusion will have pain to direct pressure over the weight-bearing portion of the heel. There may also be local swelling, and eventually bruising. The extent of the injury can vary widely. Some patients with a mild heel contusion will have some pain, but will able to walk reasonably normally in comfortable shoes with a soft shock absorbing insert protecting the heel. Other patients with more severe heel bruising, may not be able to load significantly through the heel for a number of weeks.

Imaging studies

X-rays of the affected heel will not demonstrate a fracture. Occasionally an undisplaced fracture will be present, but not seen on plain x-rays. These injuries can be diagnosed via an MRI or CT scan.

Treatment of Heel Contusions

Heel contusions can be treated conservatively –although they may take a considerable period of time to fully heal.

The main treatment is time and rest to allow the soft tissue injury to heal.

Initially, elevation, icing, and staying off the foot will allow the pain symptoms to settle. Anti-inflammatory medication may also help with symptoms at this time.

As symptoms improve patients may start to bear some weight through the heel. Wearing comfort shoes with a soft orthotic or heel pad can be helpful. Limiting the amount of standing and walking initially will be necessary.

Gradually over time the amount of loading through the heel as well as the intensity of activities will be able to be increased. During this period some physical therapy working on gentle soft tissue mobilization may be helpful.

Most heel contusions will heal well with time and appropriate rehabilitation. However, residual heel pain can occur after recovery from this injury.

Edited January 12, 2024