Bruised heel: treatment, recovery time and when it’s more serious

What is a bruised heel?

A bruised heel is an injury to the thick pad of fat that cushions the bottom of your heel bone (the calcaneus). A hard landing, or thousands of smaller impacts, crushes the fat pad against the bone. Tiny blood vessels break, and the area becomes sore and sometimes swollen. People also call it a stone bruise.

There are two kinds, and they heal at different speeds:

• A soft-tissue bruise affects the fat pad and the tissue around it. It’s the most common kind and usually heals in 1 to 3 weeks.
• A bone bruise is bleeding and swelling inside the heel bone itself, from a harder impact. It isn’t a fracture, but it hurts more, lasts longer and doesn’t show on a regular X-ray.

Bruised heel symptoms

• pain under the heel, usually in the center, when you stand or walk
• tenderness when you press on the bottom of the heel
• pain that’s worse barefoot on hard floors, or each time your heel strikes the ground
• mild swelling
• sometimes a red, purple or blue mark, although the fat pad is thick, so many bruised heels show no color at all
• a limp, or walking on your toes to keep weight off the heel

Is it a bruised heel or plantar fasciitis?

Plantar fasciitis, irritation of the thick band of tissue along the bottom of your foot, is the most common cause of heel pain, and it can feel a lot like a bruise. A stress fracture, a small crack in the heel bone from repeated impact, can too. Here’s how they usually differ:

If your heel pain started without an injury and is worst with your first steps in the morning, read our guide to heel pain in the morning. For other kinds of foot pain, see sharp pain in the foot.

What causes a bruised heel?

Common causes include:

• landing hard from a jump or a fall, for example off a ladder, a step or during basketball
• stepping down hard on a rock or another hard object
• repeated pounding, such as running on pavement, jumping sports or standing all day on concrete
• walking barefoot on hard floors

Some things make a bruised heel more likely:

• a heel fat pad that has thinned with age, so the bone takes more of the impact
• excess body weight
• shoes with thin or worn-out soles
• a sudden increase in running, walking or time on your feet

Why does my heel feel bruised when I didn’t injure it?

A bruised feeling without an injury is common. The usual causes are plantar fasciitis (especially if it’s worst in the morning), a thinning fat pad, repeated impact on hard floors, worn-out shoes and, if you’ve recently stepped up your activity, a stress fracture. If the feeling lasts more than a week or two, or keeps coming back, have it checked.

How to treat a bruised heel

The first 2 to 3 days

1. Rest the heel. Cut back on standing and walking, and stop running and jumping. If every step hurts, use crutches for a few days.
2. Ice it for 15 to 20 minutes every 2 to 3 hours, with a thin cloth between the ice and your skin.
3. Raise your foot above the level of your heart when you sit or lie down, to limit swelling.
4. Take an over-the-counter pain reliever such as ibuprofen (Advil, Motrin), naproxen (Aleve) or acetaminophen (Tylenol), if it’s safe for you. Check with your doctor or pharmacist first if you have kidney, stomach or heart problems, or take a blood thinner.

Avoid heat, such as hot baths or heating pads, for the first 2 to 3 days, because it can increase swelling.

If you have diabetes, neuropathy or poor circulation, don’t use ice or heat on your foot, and have any heel injury checked by a podiatrist. You may not feel if the cold or heat is damaging your skin.

Cushion and protect the heel

• Wear cushioned shoes with a thick, shock-absorbing sole and a firm heel counter (the stiff cup at the back of the shoe), even around the house.
• Add a heel cup. A gel or silicone heel cup cushions the heel and helps hold the fat pad in place under the bone. They’re inexpensive and sold at most pharmacies.
• Don’t go barefoot on hard floors, and skip flip-flops and thin, flat shoes until the heel settles.
• Ask about heel taping. Tape wrapped around the heel can squeeze the fat pad under the bone for extra cushioning. The evidence for it is limited, but some people find it makes walking easier. A podiatrist or physical therapist can show you how.

What to do when walking is too painful

Most bruised heels hurt to walk on for a few days and then ease. Until they do:

• use crutches, or keep trips on your feet short, in your most cushioned shoes with a heel cup
• keep the things you need close by, so you make fewer trips
• sit down for tasks you’d normally stand for

If you can’t put any weight on the heel at all, or can’t manage 4 steps, don’t assume it’s a bruise. Have it X-rayed to rule out a fracture. See when to see a doctor below.

Getting back to exercise

• Stay fit with low-impact exercise, such as swimming or cycling, while the heel heals.
• Go back to running or jumping only once you can walk briskly without pain.
• Start with short, easy sessions on softer surfaces, and build up over 1 to 2 weeks.
• If the pain comes back, drop back to the last level that felt fine.

How long does a bruised heel take to heal?

Most bruised heels heal in 1 to 3 weeks. A bone bruise usually takes 6 to 8 weeks, and sometimes a few months. These are typical times, not promises. Healing depends on how hard the impact was, your age and health, and how well you can rest the heel.

Bruised heel bone: what’s different?

A bone bruise usually follows a harder impact, such as a fall from a height or a bad landing. Signs that the bone, not just the fat pad, is bruised:

• a deep ache inside the heel, not just soreness on the surface
• pain even when you’re resting
• pain that’s still there after 2 to 3 weeks of good care

Bone bruises don’t show on a regular X-ray, but an X-ray is still worth having to rule out a fracture. An MRI can confirm a bone bruise if needed.

Treatment is the same as for any bruised heel, just for longer: more time off impact, good cushioning, and sometimes a walking boot for a few weeks to take pressure off the heel. Most bone bruises heal in about 6 to 8 weeks, although some take a few months. Going back to running too early is a common reason they drag on.

Is it a bruised heel or a broken heel?

The heel bone can break, usually from a fall or jump from a height, or a car accident. A heel fracture is a serious injury that needs prompt care. These signs point to a fracture rather than a bruise:

• you can’t put any weight on the foot
• the swelling is severe and comes on fast
• bruising spreads along the sides of the heel and into the arch
• the heel looks wider, flatter or out of shape
• the injury came from a fall or jump from a height

A heel stress fracture builds up gradually from repeated impact. The heel hurts when you squeeze both sides of it, and the pain gets worse with activity. It may not show on an X-ray for the first few weeks, so an MRI is sometimes needed. Our guide to telling a foot fracture from a sprain explains how foot injuries are diagnosed.

When to see a doctor for a bruised heel

Go to the emergency room if:

• you fell or jumped from a height and have severe heel pain, especially with back pain, because the same fall can injure the spine
• the heel looks deformed, or bone is showing through the skin
• your foot turns cold, pale or blue, or goes numb

Get seen the same day if:

• you can’t put weight on your foot, or can’t manage 4 steps
• the swelling is severe or getting worse quickly
• you have diabetes, neuropathy or poor circulation and have hurt your foot

Book a visit if:

• the pain isn’t clearly better after 1 to 2 weeks of home care
• it still hurts after 3 weeks
• the pain keeps coming back, or your heel feels bruised without an injury
• you have numbness, tingling or burning in the heel

How a podiatrist treats a bruised heel

A podiatrist will ask how the injury happened, press on different parts of the heel and watch you walk. Evolve Health podiatrists have digital X-ray on site, so they can usually check for a fracture at your first visit. An MRI or ultrasound may be ordered if a bone bruise, stress fracture or soft-tissue injury is suspected.

Depending on what they find, treatment may include:

• heel cups, padding or taping to cushion the heel
• a walking boot for a few weeks for a bone bruise or stress fracture
• custom orthotics if your heel keeps getting bruised or the fat pad has thinned
• physical therapy to get you back to running or sport safely
• treatment for plantar fasciitis or another cause, if the pain turns out not to be a bruise

Learn more about how we treat heel pain and plantar fasciitis.

How to prevent a bruised heel

• Replace running shoes every 300 to 500 miles, and any shoes once the heel cushioning has worn down.
• Wear cushioned, supportive shoes on hard floors, at home and at work.
• Use heel cups for high-impact sports, or if you’ve bruised your heel before.
• Ask your podiatrist about custom molded orthotics, which cushion and support the heel with every step, especially if you’re on your feet a lot or your heel keeps getting bruised.
• Build up running, jumping and time on your feet gradually.
• Land softly when you jump, with your knees bent.
• Keep a healthy weight to reduce the load on your heels.

If your heel still hurts after 2 or 3 weeks, or you’re not sure it’s just a bruise, you can find a podiatrist near you and book online.