What is the typical recovery time for a bruised calcaneus (heel bone)?

Recovery Time for a Bruised Calcaneus

Recovery from a bruised calcaneus typically takes 2 weeks to 4 months, depending on the severity of the bone bruise, with most cases resolving within 6-8 weeks of conservative management.

Expected Recovery Timeline Based on Severity

• Mild bone bruises resolve within the first 2 weeks after trauma, allowing return to weight-bearing activities 1
• Moderate to severe bone bruises require partial weight-bearing for up to 4 months, with complete resolution of MRI signal changes evident at 6 months 1
• If pain persists beyond 6-8 weeks of appropriate conservative treatment, subspecialist referral is warranted 2

Initial Management Approach

First 3-5 Days Post-Injury

• Protect and immobilize the foot immediately if severe pain or swelling is present 2
• Limit complete immobilization to 3-5 days maximum, as prolonged immobilization causes muscular atrophy and worsens functional recovery 2
• Apply cryotherapy to reduce inflammation 2
• Prescribe NSAIDs (such as ibuprofen 400 mg every 4-6 hours) for pain relief 2

After Initial 3-5 Days

• Commence active exercise and avoid complete immobilization beyond this point 2
• Initiate early weight-bearing as tolerated to facilitate faster recovery 2
• Increase mobilization and weight-bearing gradually, as bone bruises pose a potential risk for chondrolysis and stress fracture 1

Diagnostic Considerations

• Obtain radiographs initially if the patient meets Ottawa Ankle Rules criteria (inability to bear weight immediately after injury, point tenderness over the calcaneus, or inability to ambulate 4 steps) 3
• If radiographs are negative but pain persists >1 week, MRI without contrast is the reference standard for identifying bone bruises with associated bone marrow edema patterns 4, 3
• MRI shows characteristic findings for calcaneal bone bruises, with signal changes that may take up to 6 months to completely resolve 1

Rehabilitation Principles

• Combine mobilization therapy with exercise therapy for range of motion deficits, as mobilization alone is insufficient 2
• Use semirigid braces over tape for functional support during rehabilitation, as braces are more cost-effective 2
• Avoid complete immobilization, which causes muscular atrophy and deconditioning 2

Critical Pitfall to Avoid

• Do not increase impact activities too early, as this can lead to prolonged recovery or development of a more severe bone bruise requiring an additional 2-9 months for resolution 5
• Reexamine at 3-5 days post-injury, as excessive swelling and pain can limit the initial examination within 48 hours 3

When Recovery Is Delayed

• If no improvement after 6-8 weeks of appropriate conservative treatment, refer to podiatric foot and ankle surgery 2
• Consider advanced imaging (MRI or bone scan) if clinical suspicion remains high despite negative radiographs 2
• Evaluate for underlying conditions if bilateral symptoms or systemic inflammatory conditions are present 2