What is a Stone Bruise on the Bottom of the Foot or Heel?

By Steven Gershman DPM  /  February 21, 2024 Blog Home

A stone bruise is a non-medical term or colloquialism used to describe localized pain on the bottom of the foot in one specific spot. 

Understanding stone bruises

What is a stone bruise?

Wikipedia uses the term ‘metatarsalgia’ to explain in medical terms what a stone bruise is.  Healthline describes stone bruises as either metatarsalgia, or plantar fasciitis or a stress fracture. An article in the American Academy of Podiatric Sports Medicine describes stone bruises as probable metatarsalgia.  

The bottom line here is that most resources describe a stone bruise as metatarsalgia. Metatarsalgia is pain at the ball of the foot, where the metatarsal bones connect to the toes or phalangeal bones.  

Causes of stone bruises

At the metatarsal-phalangeal joints, where the metatarsal bones meet the toes, the metatarsals have heads that are prominent or in effect protrude out, and can be felt when touching the ball of the foot. These are very sensitive to pain. Normally, there is a fat pad that protects the bone heads from impact. However, as we age the fat pad thins and is pushed further toward the toes, losing its protection of the metatarsal heads.  

A stone bruise can occur at any of the five metatarsal heads from stepping on a hard object, like a stone, or from constant impact on the area while walking or running. In effect, it is a bone bruise to the metatarsal head bone. Symptoms are sharp pain or ache directly at the impacted area. 

In some cases, one of the metatarsal heads can stick out of the bottom of the foot or become enlarged, so it picks up more pressure when walking or running. This is a common area of a stone bruise or metatarsalgia. The large first metatarsal bone is particularly prone to this, as it often protrudes the most and bears the greatest pressure during normal gait.

Another type of stone bruise is known as sesamoiditis. Sesamoids are two small round bones located beneath the first metatarsal head. These bones can become irritated when stepping on a hard object or during walking or running. This condition can be quite painful.

Yet another type of stone bruise, called a neuroma, can occur at the ball of the foot, or the metatarsal heads, where a nerve becomes pinched. This type of stone bruise causes pain directly at the ball of the foot and can be triggered by stepping on a hard object that irritates the nerve or by wearing tight shoes that squeeze the nerve.

In addition, a stone bruise can also manifest at the bottom of the heel.

The heel bone, known as the calcaneus, has two bumps or tubercles on the bottom, which bear weight during standing, walking, or running. Either of these bumps can become painful from stepping on a hard object or repetitive impact, resulting in a bruising effect on the bone.

All stone bruises cause pain when weight bearing and typically do not present symptoms when off the feet. Therefore, footwear plays a significant role in both the development and treatment of stone bruises.

How do you prevent a stone bruise on your foot?

Shoes serve as the foundation for our feet. A lack of shock absorption is a major cause of stone bruises. The midsole of the shoe plays a critical role in proper shock absorption. If the midsole is too thin, too soft, or worn out, increased forces will pound on the foot during walking or running. These forces are most pronounced at the heel and ball of the foot and can lead to stone bruises. 

Proper fitting shoes are also an important factor. Shoes that are too tight in the toe box can affect the metatarsals, making them more prone to issues like metatarsalgia. A round, wide toe box can reduce the risk of stone bruises.

Of course, going barefoot is another potential cause of stone bruises. The foot is left unprotected from the ground, and if the metatarsals or heel bear a lot of weight, it can lead to stone bruises.

Preventing stone bruises is possible. 

comes down to proper shoes that fit correctly, are wide and long enough, and have well made midsoles and outsoles to protect the feet from ground forces. Keeping shoes too long until worn out is another recipe for stone bruises. 

Prevention boils down to wearing proper shoes that fit correctly, are wide and long enough, and have well made midsoles and outsoles to protect the feet from ground forces. Keeping shoes until they are worn out is another recipe for stone bruises. The best shoes also feature superior insoles to add protection to the foot, with some arch support and heel cushioning.

If you wear slippers, make sure they have a solid outsole and some inner support. Again, avoid going barefoot.

Shoes should typically be replaced yearly. If the outsole is overly worn sooner, then replace them sooner. Worn out shoes are a recipe for foot problems.

Orthofeet's solution

Orthofeet offers orthopedic shoes that are well constructed to help avoid stone bruises. They feature well made insoles and outsoles for protection. In addition, the toe box is round and wide, going all the way to extra extra wide.

The shoes come with insoles that offer arch support and cushioning, along with added heel cushioning. These insoles are removable, allowing for the addition of orthotic insoles if needed. Even Orthofeet’s slippers come with these high quality, removable insoles.

I personally recommend Orthofeet shoes to my patients, and I wear them myself, as does my wife and mother. They are the most comfortable shoes I have ever worn.