I want to discuss a common heel injury that often occurs this time of year. A stone bruise of the heel is an annoying injury that occurs when one steps on a rough, protruding object that hit’s the foot directly on the bottom of the heel. The object is often a loose or protruding stone, but can also be another material, such as a root, wood chip, child’s toy, or anything else that is small enough to stick directly into the heel. Usually, one becomes injured when walking barefoot, but flimsy soled shoes such as flip-flop sandals or house slippers can also allow the object to hurt the heel tissue. It is seen in fall amongst hikers because as the leaves fall, they cover hazards like rocks and roots, and hikers often fall prey to stepping on these objects. Although hiking boots offer great protection from these objects, some athletic shoes or flimsier casual shoes do not. In this injury, pain is felt directly under the heel with every step and essentially feels like there is a deep bruise in that area.
There are three types of tissue that are injured by the hard contact of this object. The plantar fascia, a ligament discussed elsewhere on this website, can become directly bruised where it attaches to the heel bone, leading to plantar fasciitis. This debilitating condition ultimately can become chronic is it spreads beyond a simple bruise, leading to long-term heel and arch pain if not treated appropriately with stretching, anti-inflammatory medications/injections, icing, and arch support. Another tissue potentially injured by the object is a pad called a bursa. Also known as a bursal sac, this pillow-like tissue provides some degree of protection and shock absorption to the bottom of the heel bone, and a protruding object can irritate this tissue and cause it to become inflamed. Bursitis, as it is called, can be difficult to treat in the heel, and can take a while to recover from. Treatment is similar to treatment for plantar fasciitis. The body has many bursal sacs throughout the body providing the same sort of bony protection, although the heel bursa seems to take much more of a beating than any of the others. Finally, the heel bone itself can be injured when stepping on a small protruding object. The bone does not typical fracture in this case but does become bruised in the process, with minor bleeding occurring within the bone from the shock of the injury. It is this type of bruise that is typically associated with the stone bruise process. Of the three injured tissue types, a bone bruise is the hardest to treat because there is not much that can be done for treatment other than activity rest and heel support (like using a walking boot). It can take several months before the pain goes away, and if one does not take it easy during recovery the continued shock and pressure from lengthy walking or running can lead to a stress fracture of the heel bone, which can take even longer to heal.
As you can see, a stone bruise has a nasty reputation for being both annoying and difficult to quickly treat. Keep this in mind when navigating the beautiful landscape, and later on in the winter when holiday toys scatter the floor for those of you with kids.