Differential Diagnosis for Heel Pain Focal at Medial Tuberosity
Single Most Likely Diagnosis
- Plantar Fasciitis: This is the most common cause of heel pain, especially when it's focal at the medial tuberosity. The condition is characterized by inflammation of the plantar fascia, which can cause pain and stiffness, particularly after periods of rest or at the start of activity. The absence of a reported injury and the location of the pain support this diagnosis.
Other Likely Diagnoses
- Medial Calcaneal Nerve Entrapment: Entrapment of the medial calcaneal nerve can cause heel pain, especially if it's localized to the medial aspect of the heel. This condition might not be as common as plantar fasciitis but is a plausible cause for heel pain without a history of trauma.
- Achilles Tendinopathy: Although more commonly associated with pain at the back of the heel, Achilles tendinopathy can sometimes cause pain that radiates or is referred to the medial aspect of the heel, especially if the condition is severe or chronic.
- Fat Pad Atrophy or Inflammation: The fat pad under the heel can become inflamed or atrophied, leading to heel pain. This condition might be more common in older individuals or those with a history of steroid injections into the heel.
Do Not Miss Diagnoses
- Infection (Osteomyelitis or Soft Tissue): Although less likely, an infection in the bone (osteomyelitis) or soft tissues of the heel can cause focal pain and must be considered, especially if there are systemic symptoms such as fever or if the patient is immunocompromised.
- Tumor (Benign or Malignant): Tumors, whether benign (like a plantar fibroma) or malignant, can cause heel pain. While rare, missing a diagnosis of a tumor could have significant consequences.
- Fracture (Stress or Insufficiency): Even without a history of injury, stress fractures or insufficiency fractures can occur, especially in individuals with osteoporosis or those engaging in new or increased physical activity.
Rare Diagnoses
- Bursitis: Inflammation of the bursae around the heel can cause pain, but this is less common and usually associated with specific activities or positions that irritate the bursae.
- Tarsal Tunnel Syndrome: This condition involves compression of the posterior tibial nerve as it travels through the tarsal tunnel on the inner side of the ankle. While it can cause pain and numbness in the foot, it's less commonly associated with isolated heel pain.
- Seronegative Arthropathies (e.g., Psoriatic Arthritis, Reactive Arthritis): These conditions can cause heel pain due to enthesitis (inflammation at the sites where tendons or ligaments insert into the bone), but they are less common and usually part of a broader clinical picture that includes other symptoms and signs.