Differential Diagnosis for Heel Pain in a 10-year-old Patient
The patient's presentation of heel pain radiating up the Achilles tendon, worsening with activity, suggests several potential diagnoses. Here's a categorized differential diagnosis:
Single most likely diagnosis
- Sever's Disease (Calcaneal Apophysitis): This is the most common cause of heel pain in children, especially during periods of rapid growth. It is characterized by inflammation of the growth plate in the calcaneus, leading to pain and tenderness. The patient's age, symptoms, and activity-related exacerbation make this diagnosis highly plausible.
Other Likely diagnoses
- Achilles Tendinitis: Inflammation of the Achilles tendon can cause pain and stiffness, especially with activity. While more common in adults, it can occur in children, particularly those involved in sports.
- Plantar Fasciitis: Although less common in children, plantar fasciitis can cause heel pain that radiates. It is often associated with overuse or poor foot mechanics.
- Overuse Injury: Given the activity-related increase in pain, an overuse injury affecting the muscles, tendons, or bones of the foot or ankle is a possible diagnosis.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Osteomyelitis or Septic Arthritis: Infections of the bone or joint can present with localized pain and should be considered, especially if there's a history of trauma, fever, or systemic symptoms.
- Tumor (e.g., Osteoid Osteoma): Although rare, bone tumors can cause persistent, worsening pain and must be ruled out, particularly if the pain is constant and not entirely relieved by rest.
Rare diagnoses
- Fracture (Stress or Traumatic): While less likely without a history of significant trauma, stress fractures or small, non-displaced fractures could cause heel pain.
- Inflammatory Conditions (e.g., Juvenile Idiopathic Arthritis): Systemic inflammatory diseases can cause musculoskeletal pain, including heel pain, and should be considered if other symptoms are present.
- Neurological Conditions: Certain neurological conditions can refer pain to the heel area, though these would be uncommon and typically associated with other neurological symptoms.