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 adolescence. 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 those who are overweight or engage in sports activities that involve running or jumping.
- Achilles tendonitis: 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 bruise: A direct blow to the heel can cause pain and swelling.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Osteomyelitis: A bone infection that can cause severe pain, redness, and swelling. Although rare, it is a serious condition that requires prompt medical attention.
- Bone tumor (e.g., osteosarcoma, Ewing's sarcoma): Although rare, bone tumors can cause heel pain and must be ruled out with imaging studies.
- Fracture: A stress fracture or other type of fracture can cause heel pain, especially if the child has a history of trauma.
- Rare diagnoses
- Kohler's disease: A rare condition that affects the navicular bone in the foot, causing pain and swelling.
- Freiberg's disease: A rare condition that affects the metatarsal bones in the foot, causing pain and swelling.
- Tarsal coalition: A rare condition where two or more bones in the foot are abnormally connected, causing pain and stiffness.