Differential Diagnosis for Heel Pain

The patient's symptoms of heel pain that worsens at night, upon rising after sitting, and resolves with more movement, while taking 10,000 steps a day, suggest several potential diagnoses. These can be categorized as follows:

• Single Most Likely Diagnosis

  • Plantar Fasciitis: This condition is characterized by inflammation of the plantar fascia, a band of tissue that runs along the bottom of the foot. The symptoms described, such as heel pain that is worse after periods of rest (especially at night or after sitting) and improves with movement, are classic for plantar fasciitis. The high level of daily activity (10,000 steps) could exacerbate this condition.

• Other Likely Diagnoses

  • Achilles Tendinitis: Inflammation of the Achilles tendon can cause heel pain, especially if the tendon is strained from overuse, such as taking a high number of steps daily. However, the pain pattern might not exactly match the described improvement with movement.
  • Fat Pad Atrophy: This condition involves the loss of the fat pad under the heel, leading to less cushioning and potentially more pain, especially with weight-bearing activities. It might not fully explain the improvement with movement but could contribute to heel pain.
  • Heel Spur: A bony growth on the underside of the heel bone, which can cause pain when walking or standing. While it could be a factor, the specific pattern of pain improvement with movement is less typical for heel spurs.

• Do Not Miss Diagnoses

  • Infection (e.g., Osteomyelitis or Septic Arthritis): Although less likely, infections in the foot or ankle can cause severe pain and must be considered, especially if there are signs of infection such as redness, swelling, or fever.
  • Tumor: Both benign and malignant tumors can occur in the foot and cause pain. While rare, missing a diagnosis of a tumor could have significant consequences.
  • Fracture: Stress fractures or other types of fractures in the heel or foot could cause pain that worsens with activity. Missing a fracture could lead to further injury.

• Rare Diagnoses

  • Rheumatologic Conditions (e.g., Rheumatoid Arthritis, Psoriatic Arthritis): These conditions can cause foot pain, including heel pain, but would typically be accompanied by other systemic symptoms or signs of arthritis in other joints.
  • Nerve Entrapment (e.g., Tarsal Tunnel Syndrome): Compression of nerves in the foot can cause pain, numbness, or tingling. While possible, the specific pattern of pain described is less typical for nerve entrapment syndromes.
  • Paget's Disease: A condition of bone that can cause pain and deformity, but it is rare and would likely have other associated symptoms or findings.