The Center for Podiatric Care and Sports Medicine

Black and Blue All Over: Foot and Ankle Bone Bruises

Posted by on Wednesday, September 26th, 2012

Do you remember when you were a wee little kid, just old enough to start really playing in a physical way? Maybe you were out in the yard or a park or just running around inside the house when the inevitable happened: you fell or banged into something. After what you would later have to agree was an excess of hysterical tears, you find that you have on your elbow or knee what some moms call a boo-boo or a black and blue mark. You know, a bruise. You’ve probably had many more since then and probably don’t think twice about them anymore unless they’re unusually colorful and you want to show them off to your horrified friends.

Those kinds of bruises are soft tissue bruises, where the trauma breaks blood vessels that then bleed into the layers of skin, causing the discoloration that we think of when we talk about bruises. There are, however, other kinds of bruises. No, I don’t mean a bruised heart, I mean a bone bruise–an injury that often affects your feet and ankles.

What is a bone bruise? A bone bruise is like a soft tissue bruise, except, of course, it affects a bone rather than the soft tissues. The most common type is a sub-periosteal hematoma.

That sounds fancy rather than common. What is it? Our bones are covered by a membrane called the periosteum. There are a lot of blood vessels in the periosteum, so when there is  a direct impact on the bone, some blood vessels can break, allowing blood to pool between the membrane and the bone. Space is tight in there, though, so the blood doesn’t haven’t much room to spread out as it can in the layers of skin. Instead, the blood in a bone bruise is confined to a small area, forming a lump under the periosteum.

Okay, what can cause a bone bruise? Like soft tissue bruises, they come from severe impact with a hard surface–falls, jumping and landing on a hard surface, a direct blow from someone or something. Extreme twisting can cause bone bruising when the surfaces of the bones in the joint clash hard. It’s not unusual to find bone bruises along with bad ankle sprains.

So let’s say that the top of my foot really hurts. How do I know if I have a bone bruise or a broken bone? Well, pain is a good indication, but unfortunately it’s an indicator for just about every other foot injury. Swelling is a symptom of a bone bruise, and there may be discoloration as well. The only way to find out for certain, though, whether you have a bone bruise is to see a podiatrist at The Center for Podiatric Care and Sports Medicine (212.996.1900) and have your foot or ankle fully examined; often an MRI is the only way to definitively diagnose a bone bruise.

You know, a player on one of my fantasy teams has a bone bruise on his foot and he’s been limping around and playing badly for weeks. When I have a bruise, it stops hurting in a day or two. Is this player just lazy? No, this is probably the biggest difference between soft tissue bruises and bone bruises. Like you said, a soft tissue bruise usually is gone in a few days, but bones heal more slowly than soft tissue. A bone bruise is only one step away from a fracture, so think more of the time frame for healing a fracture than a soft tissue bruise–that’s months, not days.

It’s important to take stress off the bruised bone; your podiatrist may put you in a walking boot or recommend crutches for a bone bruise on your foot or ankle. Icing the injured area can help bring down the swelling, as can anti-inflammatories such as ibuprofen or aspirin; for a natural pain reliever, you can try putting some arnica on the swollen area.

Unfortunately, the most important part of the treatment for a bone bruise are two things any active person hates: patience and rest. Yup, time to hit the pool

Bone bruises are frustrating injuries, but with the right care you can get through the healing process smoothly. Keep your feet safe and unbruised!

If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, and Dr. Ryan Minara have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.