Differential Diagnosis for an 11-Year-Old Boy with Heel Pain
Single Most Likely Diagnosis
- Calcaneal Apophysitis (Sever's Disease): This is the most common cause of heel pain in children, especially during the growth spurt of early puberty. It is characterized by inflammation of the calcaneal apophysis, which is a growth plate at the back of the heel.
Other Likely Diagnoses
- Plantar Fasciitis: Although more common in adults, plantar fasciitis can occur in children, especially if they are overweight or engage in activities that put repetitive stress on the heel.
- Achilles Tendinitis: Inflammation of the Achilles tendon can cause heel pain, especially if the child is involved in sports that involve running or jumping.
- Heel Contusion or Stress Fracture: Trauma to the heel can result in a contusion or, less commonly, a stress fracture, which would cause pain.
Do Not Miss Diagnoses
- Osteomyelitis or Septic Arthritis: Although rare, infections such as osteomyelitis (bone infection) or septic arthritis (joint infection) can cause heel pain and are medical emergencies that require prompt treatment.
- Tumor (e.g., Osteoid Osteoma): Bone tumors are rare but can cause persistent pain and should not be missed.
- Inflammatory Conditions (e.g., Juvenile Idiopathic Arthritis): Systemic inflammatory conditions can cause heel pain among other symptoms and require early diagnosis and treatment.
Rare Diagnoses
- Kohler Disease: A rare condition characterized by avascular necrosis of the navicular bone, which can cause foot pain, including heel pain, though it's more commonly associated with midfoot pain.
- Freiberg's Disease: A rare condition involving avascular necrosis of the metatarsal heads, which can cause pain in the foot but is less likely to cause isolated heel pain.
- Tarsal Coalition: An abnormal connection between two or more of the tarsal bones in the foot, which can cause foot pain, including heel pain, due to the abnormal motion and stress it places on the foot.