ألم كعب

Heel pain is one of the commonest foot complaints, and the usual cause is plantar fasciitis (also called plantar heel pain): a degenerative irritation of the thick band of tissue that runs from the heel bone to the toes, where it attaches under the heel. Pain at the back of the heel is a different problem, usually Achilles tendinopathy or a bony prominence with bursitis (Haglund deformity).

Plantar fasciitis is self-limiting. Around eight to nine in ten people recover within a year using simple measures, mainly stretching, sensible footwear and load management. It is slow, however, and there is no quick fix. A heel spur seen on X-ray is common in people with no pain at all and is not what needs treating.

Symptoms

• Stabbing pain under the heel with the first steps in the morning
• Pain on standing after sitting, which eases after a few minutes and returns after long standing
• Tenderness at the inner front edge of the heel pad
• Pain and stiffness at the back of the heel, worse going uphill or upstairs
• A bump at the back of the heel that rubs on shoes
• Burning or tingling around the heel, suggesting a trapped nerve
• In a child aged 8 to 14, heel pain with running (Sever's disease)

Causes and risk factors

Risk factors for plantar fasciitis are tight calf muscles, a recent jump in walking or running, long hours standing on hard floors, excess body weight, flat or very high arches, and thin, unsupportive shoes. It is most common between 40 and 60. Other causes of heel pain include thinning of the fat pad with age, calcaneal stress fracture, entrapment of Baxter's nerve or tarsal tunnel syndrome, Achilles tendinopathy, and inflammatory conditions such as ankylosing spondylitis and psoriatic arthritis, which should be considered when both heels hurt in a younger adult with back stiffness.

How it is diagnosed

• Clinical examination: The history and the site of tenderness normally make the diagnosis. The heel squeeze test helps to detect a stress fracture.
• Ultrasound: Shows a thickened plantar fascia, usually over 4 mm, tears and Achilles tendon changes.
• X-ray: Not routinely needed; shows spurs, Haglund deformity and some stress fractures.
• MRI: For persistent or atypical pain, to look for stress fracture, fascia rupture or other pathology.
• Blood tests or nerve studies: When inflammatory arthritis or nerve entrapment is suspected.

Treatment options

• Plantar fascia and calf stretching: Daily stretches, especially before the first steps of the day, are the most consistently effective measure.
• Footwear, heel cups and insoles: Cushioned, supportive shoes and avoiding barefoot walking on hard floors.
• Load management and weight loss: Temporarily swapping running for cycling or swimming, and reducing body weight where relevant.
• Night splints and taping: Keep the fascia gently stretched overnight; useful for marked morning pain.
• Strength training: High-load heel raise exercises for plantar fasciitis and eccentric calf loading for Achilles tendinopathy.
• Shockwave therapy: A reasonable option for symptoms lasting more than about 3 to 6 months, typically three weekly sessions.
• Injections: Steroid gives short-term relief with a small risk of fascia rupture and fat pad thinning; platelet-rich plasma has limited evidence. Steroid should not be injected into the Achilles tendon.
• Surgery: Gastrocnemius release or partial fascia release for the few with disabling symptoms after 6 to 12 months; removal of a Haglund prominence for the back of the heel.

When it is urgent

Seek urgent local care if you feel a sudden snap at the back of the ankle and cannot push off (possible Achilles rupture), cannot bear weight after a fall from height, have a hot, red, swollen heel with fever, have diabetes with a heel wound, or have heel pain together with numbness spreading up the leg.

Travelling to Türkiye for treatment

Plantar fasciitis is managed with a home programme over months, so travelling for it alone is rarely justified. If you are visiting for other reasons, an assessment with ultrasound, a properly taught exercise plan, orthoses and a course of shockwave therapy can be fitted into 2 to 3 weeks. Surgery is occasionally appropriate for long-standing cases and for Haglund deformity or Achilles problems, with about 7 to 10 days on site and protected weight bearing afterwards.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

الأسئلة المتكررة