The heel is a very important part of the foot. Without the heel, there will not be an ankle joint, ladies will not be able to wear all their fancy high – heeled shoes, athletes will not be able to run, walking and other forms of movement will be extremely difficult.
The heel is used a lot and can also get injured because of the dependence we have on it. In this article, we discuss what you need to know about a bruised heel or ‘policeman’s heel’.
What Is A Bruised Heel?
The heel is a part of the foot found just below the ankle and at the back of the foot. It is the main component of the hind foot. The major bone in the heel is the calcaneal bone which is also known as the heel bone.
The calcaneal bone is the biggest bone in the foot and plays a major role in our walking and bearing the body weight while we stand and move. The heel bone has a protective shock – absorbing fat pad which is found directly under the heel bone.
The heel pad gets bruised through a process known as a contusion. In this process, the blood capillaries or vessels get injured and there is leaking of the blood out of the vessels into the surrounding space. This forms a bruise at the heel.
How Can You Bruise Your Heel?
The heel is involved in our walking. While we walk, there are different phases in our walking cycle. When we place our feet on the ground to walk, the heel strikes the ground first, then our feet are flat, then the heel goes off, then the toes and the cycle begins again.
Due to the importance of the heel in our movement, the heel is prone to some bruising and this can happen in the following ways:
- Landing directly on your heel after jumping off a high place can cause a contusion in the heel pad.
- Repetitive running or walking in uncomfortable shoes because of the impact the heel receives can affect the heel pad. As mentioned earlier, a bruised heel is called a policeman’s heel because of the reoccurring marching and stamping they do while training which places a lot of impact on the heel pad.
- Walking, training and running barefooted places a lot of stress on the heel pad
- Training on an uneven surface affects the heel strike during the walking cycle which overloads the heel pad
- Training in the wrong shoes, especially shoes that do not provide enough support or have reached their lifespan
- Being overweight puts a lot of pressure on the heel pad which may get too tired from supporting the weight and may break down by getting bruised.
- Stepping on a hard surface or a stone
What Are The Symptoms Of A Bruised Heel?
- Pain in the middle of the heel
- Tenderness at the heel
- Pain while standing or walking
- A noticeable red or purple bruise on the heel
How Is It Diagnosed?
- X-rays are advised by the doctor or podiatrist to ensure that there is no fracture or dislocation at the heel or ankle.
- You can also self diagnose if you have a bruised heel. Put your painful foot in your hands and place the pads of your thumbs at the middle of the heel. Press around your heel gently and gradually increase the pressure as you do so until you feel pain. If the pain reduces after you remove the pressure of your thumbs, then you can say it is a bruised heel.
How Can It Be Treated?
This type of management is the first form of treated for any fresh injury. It is an acronym for Protect, Rest, Ice, Compression, and Elevation.
- The heel needs to be protected from further injury. No activity should be done while the heel is healing.
- Walking should be placed on hold. The heel needs to be well rested. This may be the use of walking aids like crutches or bed rest or wearing a heel support
- Ice helps to reduce swelling and can also help reduce the flow of fluid causing the bruising at the heel. This can be done by placing the heel in a bowl of iced water or by placing a cold pack on the heel itself. Ice should not be used for more than 15 minutes.
- Compression is the use of an elastic bandage to reduce the swelling at the heel
- Elevation is necessary to decrease the swelling and pain by raising the heel, This can be done when lying down by placing on pillows.
2. Pain Medications
Anti-inflammatory medications are prescribed by the doctors to help reduce the swelling and relieve pain at the heel joint.
The doctor will refer you to a physiotherapist who will assess the heel and gradually get you back to play if you are an athlete or get you back to normal daily activities.
The physiotherapist will:
- Relieve pain based on the findings during their assessment which may involve other joints and movement such as the ankle joint. Pain can be relieved by the use of ice, heat or other electrical modalities.
- Gentle forms of massage like kneading and stroking can help to relieve pain and prevent any tightness that may occur at the heel.
- Check for any form of muscle weakness that may arise from inactivity and may prescribe some exercises as the heel heals
- Reduce any form of swelling caused by the injury
- Retrain your walking cycle and correct any abnormalities
- Prevent a relapse. This means as you start to bear weight on the heel, they will take your shoes and other things into consideration and provide lifestyle modification in order to avoid an injury.
Follow up sessions will be requested to ensure that the heel has properly healed and to also avoid any complications.
What May Happen If A Bruised Heel Is Not Well Treated?
- A bruised heel bone. Since the protective internal heel pad is not properly treated, the shock from the ground while walking is placed on the calcaneus. This can cause injury to the bone.
- A stress fracture can occur in the calcaneal bone. Since the heel bone is not used to absorbing all the shock, it can affect the bone and can lead to a fracture within the bone.
- It can affect the walking pattern and you may begin to walk on your toes or with a limp because you are still avoiding weight bearing on your heel
- Severe muscle weakness and wasting. The body has a way of compensating when there is an injury. The calf muscles, for example, may reduce in size because they are not being used properly as we walk.
- Ankle stiffness. The heel needs to move with the ankle and vice versa. If there is no movement, the ankle is forced to be in a particular position which can cause muscle stiffness.
How Long Does It Take To Heal?
If the heel is treated properly from the onset, it will take about a week to three weeks to heal but if not properly treated, it may take about six weeks to heal.
How Can It Be Avoided?
- Wear appropriate shoes while walking or exercising. Wearing the right type of shoes provides support for the heel pad while exercising or doing other forms of activities.
- Stop doing activities barefooted
- Invest in heel pads which can add extra protection to the already injured heel pad
- Lose weight in order to reduce the pressure on the heel pad
- Check your sporting shoes. Check the soles to ensure that they are not wearing off as this can cause the heel pad to absorb more shock than the shoe itself.
- Check your playing or training surfaces and ensure they are even
A bruised heel is an injury to the heel pad that protects the heel while we move and jump. However, too much activity can affect the heel pad and may lead to a lot of discomfort.