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Heel Fat Pad Bruising

In today’s blog topic, we will be discussing calcaneal fat pad contusion or also known as bruised heel, or stone bruising. It is commonly mistaken for, or misdiagnosed as, plantar fasciitis due to the similarities in the conditions, however as we will explain, there are a few distinct differences.

Fat Pad contusion occurs when the protective layer on the bottom of our calcaneus, or heel, becomes damaged, bruised or moves. Our calcaneus is protected by a pad made up of elastic fibrous tissue separating closely packed fat cells. This pad acts as a shock absorber and separates the bone and the skin.

Damage can be caused due to an acute traumatic event, such as landing from a height, or repetitive trauma such as excessive running or marching on hard surfaces. Structures surrounding the heel bone are prone to injury as the heel bears a lot of weight during walking, running and jumping activities.

This injury is common amongst long distance runners, soldiers and athletes that take part in jumping activities.

There are several causes for fat pad bruising, both acute and chronic, such as:

1. A fall from a height onto a hard surface can cause bruising of the fat pad and structures surrounding the heel.

2. Stepping on a rock or hard surface with bare feet.

3. Repetitive jumping activities on hard surfaces can cause acute trauma to the heels, bruising the fat pad.

4. Marching like activities can place excessive pressure on the heels, causing trauma.

5. Poor footwear with no cushioning can result in bruised heels. This occurs due to repetitive stress on the heels over a prolonged period.

Symptoms of a fat pad contusion can include:

1. Debilitating or sharp pain on the bottom of the heel during activity or weight bearing.

2. Pain in the heel on deep palpation through the calcaneum

3. Associated redness, or bruising, on bottom of heel.

4. The pain will be felt almost directly in the centre of the heel. Unlike planter fasciitis, pain is central to the heel, rather than felt in the arch or centre of the base of the foot. Whilst plantar fasciitis pain CAN be felt in the heel and arch, fat pad contusion will only be felt in the heel.

The differences between plantar fasciitis and a fat pad contusion are as follows:

Diagnosis of a fat pad contusion by be made clinically by a suitably qualified practitioner, such as a physiotherapist or chiropractor. This process will include a through subjective and objective examination including a history of traumatic event or excessive jumping activities as well as assessment of any biomechanical or functional abnormalities of the feet. Clinical and visual examination including palpation of the painful area and potentially MRI or a diagnostic ultrasound can be used to assist in the confirmation of fat pad bruising.

Treatment for fat pad contusion involves cessation of any activity that aggravates the condition such as running, jumping, lifting weights as well as a period of de-loading the heel. This maybe done with the use of crutches or taping techniques, depending on the severity of the condition.

Massage and soft tissue therapy will be used to reduce the tension in the surrounding muscles, mobilisation will be applied to the joints of the ankle to provide better shock absorption to the surrounding joints, as well as taping to “create” a cushion on the heel. This taping uses a basket weave technique to cup the fat pad and reduce stress through the area.

Recovery from a fat pad contusion is relatively quick and very successful with conservative treatment, however in advanced cases a corticosteroid injection may also be beneficial.

There are a few things you can do to reduce the chances of developing a fat pad contusion, including:

· Replacing your footwear often, every 1000km’s, and definitely before the grip wears away.

· Using footwear that has good heel cushioning with a greater shock absorbing impact at the heel.

· Using silicone heel cups in harder soled shoes (dress shoes)

· Have your lower limb biomechanics assessed, to see if you may benefit from orthotics

So that’s a brief overview of how fat pad contusion can occur and how to avoid it. If you have questions or comments feel free to e-mail us at admin@cbdwellnesscentre.com.au and we will happily answer them for you.

If you suffer with persistent pain through the heel, feel free to call us on (08) 9486 8653 and our therapists will be happy to chat with you about the best management plan.


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