Fat Pad Contusion

The fat pad of the heel provides a protective layer over the heel bone. This pad can become damaged or moved to a less useful area due to a single injury or long term wear and tear. When the fat pad is weakened like this, the heel becomes more prone to bruising. Fat pad contusions are common among athletes whose activities carry the risk or necessity of repetitively bumping the heel.

Symptoms

Pain to the heel area which may be exacerbated if the heel is moved against weight or pressure. Other possible symptoms include tenderness, irritation of the skin and excessive heat. These symptoms are particularly likely to be associated with a bruised heel if they follow on from sharp, sudden foot movements, a fall or a similar abrupt change in body position.

Causes

A direct impact to the heel, either due to landing forcefully or from the strike of a projectile, often causes a fat pad contusion. Heavy landings can occur as an accident (such as while cycling) and are also regularly encountered in contact sports like football, rugby or basketball. Another frequent cause is prolonged strain or strikes to the heel over time or in one session, for example a runner or jumper pressing hard against a surface. Such blows can dislodge and injure the protective fat pad, leaving the heel open to contusions. Sudden changes in body or foot position – such as rapidly turning – can also contribute to the injury.

In some cases the heel injury might be linked to overuse; insufficient warm ups, overexertion or training with fatigued muscles can all lead to overuse injuries. One of these injuries is plantar fasciitis; if you suspect this condition, please see our corresponding article.

Treatment

Take immediate rest from all activity involving pressure to the heel. Ice the area appropriately for a few minutes at least 3 times per day to help relieve pain and any swelling. In the first day following the injury, try not to put any weight on the heel. After 3 days apply heat treatment, such as heating pads, warm water or showers. When beginning to walk on the heel again, seek out a suitable pad or cup to fit inside your shoe; this will assist with shock absorption and should help to keep the pain at bay while moving. Return to sports activity gradually, being careful not to continue training if you feel pain or other symptoms. It may not be necessary to see a doctor but people experiencing debilitating pain or suspecting a related injury should consult a professional. Also talk to a doctor if you feel you would benefit from taping the heel.

Recovery

A bruised heel can recover within a few days if you notice the symptoms and take them seriously, whereas continuing to train on the injured heel can lead to a prolonged period of treatment and inactivity. Therefore it is essential to take appropriate rest from all activities which could potentially damage or strain the heel in any way. It is also important to inspect your footwear and replace any inefficient or worn shoes. Running shoes should be replaced after 400-500 miles of running. You should begin to wear shock absorbent shoes when feasible in order to further protect the heel and fat pad.