Calcaneal/heel bone stress injury: bruising to fractures

Calcaneal, or heel, bone stress injury covers injuries from bone stress reactions (often referred to as a “bruised bone”) to stress fractures and causes significant heel pain with loading.

The heel pain can be difficult to localize and may be felt underneath, on the sides or back of the Calcaneus (heel bone).

The pain is often constant after loading and can remain at a heightened level for several days after activity.

The injury begins gradually, although it can peak suddenly, and is typically associated with increased load (eg. starting a new sport, more training time, increasing bodyweight).


Your bone density peaks around 23 years of age, so if you’re less active and/or have poor nutrition before that age, you’re more prone to bone stress for life.

If your post-exercise pain settles within 24 hours, you most likely have a bone stress reaction. If it hangs around for 3 days or more, it’s more likely to have progressed to stress fracture.

Your only option to resolve bone stress is to reduce the bone loading. That doesn’t necessarily mean you need to stop, just improve the loading patterns on the area (eg. footwear options, improved muscular control) and avoid high risk activities (eg. hill running, rapid deceleration).

If your pain is causing altered gait patterns (eg. Limping when you walk or run), continuing activity may lead to second vary injuries due to compensatory overload.


If anti-inflammatory meds take away virtually all your pain, it’s a bad sign! Unlike most musculoskeletal conditions, bone stress symptoms disappear completely with meds like Nurofen or Voltaren so this points to a likely bone stress injury.

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While anti-inflammatory meds tend to take away the symptoms temporarily, they reduce the bone’s ability to repair itself, worsening the condition and making stress fracture more likely.

Heel striking while running is NOT associated with increased bone loading on the heel. Overstriding and fast downhill running are both risk factors though.

Complete rest isn’t required for the early stages of bone stress injuries.

Reducing the volume of weight bearing activity (eg. Running half the distance) is sufficient if you can compete it without increasing the pain.

Switching to non-impact forms of exercise, including strength work, rowing or cycling, is worthwhile to maintain strength and fitness while reducing other forms of activity.


If you’re aged between 11-14 years, it’s more likely to be Severs Disease (“growing pains”).

If it loosens up after some walking, it might be Plantarfasciitis.

If it’s worse in the morning and it’s not Plantarfasciitis, it could be a Subtalar Joint Irritation.

Pain is at the back of the heel, rather than under it, might be an Achilles tendinopathy or Retrocalcaneal bursitis.

If it happened after walking on rocky ground or in poor footwear, and it has only been a few days, it might just be a bruised heel pad.

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