A stone bruise, or calcaneal contusion, is a deep bruise affecting the heel’s soft tissues and underlying bone structure. This injury occurs when the foot sustains a sudden, forceful impact, such as stepping hard onto a small, sharp object like a stone or debris. The pain originates from damage to the protective fat pad that cushions the heel bone (calcaneus) or from a bruise directly to the bone itself. The heel fat pad acts as a shock absorber; when compressed too forcefully, internal structures become inflamed and damaged. This injury can also result from repetitive, high-impact activity like running or jumping, which gradually wears down the fat pad’s protective capacity.
Immediate Steps for Pain Relief
The initial management of a stone bruise focuses on reducing pain and inflammation within the first 24 to 48 hours using the principles of Rest, Ice, Compression, and Elevation (RICE). Resting the foot is necessary, meaning you should avoid putting weight on the injured heel to prevent further damage.
Apply a wrapped ice pack to the affected area for 15 to 20 minutes several times throughout the day. Cold therapy helps reduce pain and minimize swelling. Using compression, such as a soft elastic bandage, provides gentle support and helps control swelling. Ensure the bandage is not wrapped so tightly that it causes numbness or tingling. Elevating the foot above the level of the heart assists in draining excess fluid from the injured site.
Taking over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can also help alleviate discomfort and reduce the inflammatory response. Always follow the dosage instructions on the packaging and be aware of any contraindications, especially if you have existing stomach or kidney conditions.
Supporting the Healing Process
Once the initial acute pain subsides, the focus shifts to protecting the heel from further impact to allow damaged tissues and bone to fully recover. This healing phase can last several weeks, depending on the severity of the contusion. Protection involves switching to supportive footwear that features a rigid sole and ample cushioning to absorb ground reaction forces.
Specialized heel cups or orthotic inserts are beneficial as they redistribute pressure away from the specific point of the bruise. Donut-shaped padding, cut to offload the tender spot, can be positioned to prevent direct weight-bearing on the injury. Avoid walking barefoot on hard surfaces, as this removes necessary shock absorption and can reinjure the fat pad.
High-impact activities, including running and jumping, must be entirely avoided until the heel is completely pain-free. Returning to activity too soon risks chronic pain and a prolonged recovery timeline. Once the pain has resolved, any return to physical activity should be gradual, starting with low-impact exercises to ensure the heel can tolerate increasing forces.
Recognizing When Professional Help is Needed
While most stone bruises resolve with home management, certain signs indicate the injury may be more serious and require professional medical evaluation. If pain is so intense that it prevents you from bearing any weight on the foot, even after a day or two of rest, seek immediate medical attention. An inability to walk suggests the possibility of a significant structural injury.
Symptoms like increasing redness, warmth, streaks extending from the wound, or a fever could signal an infection requiring prompt medical treatment. Persistent numbness or tingling in the foot or toes may also indicate potential nerve involvement or compression.
Seek professional diagnosis if the pain does not begin to improve after two weeks of consistent home treatment. A healthcare provider can perform a physical examination and may use imaging tests, such as an X-ray, to rule out a stress fracture or other conditions like plantar fasciitis, which can mimic stone bruise symptoms.