Differential Diagnosis
- Single most likely diagnosis
- Plantar fasciitis: The patient's symptoms of heel pain that worsens at night and on rising after sitting, but improves with more movement, are classic for plantar fasciitis. The fact that the patient takes 10,000 steps a day also supports this diagnosis, as overuse is a common cause of plantar fasciitis.
- Other Likely diagnoses
- Achilles tendinitis: Similar to plantar fasciitis, Achilles tendinitis can cause heel pain that worsens with rest and improves with activity. However, the pain is typically more posterior and may be associated with swelling or thickening of the tendon.
- Fat pad atrophy: This condition can cause heel pain, especially in older adults or those with a history of steroid use. The pain may worsen at night and with rest, but improve with activity.
- Tarsal tunnel syndrome: This condition can cause pain, numbness, and tingling in the heel and foot, which may worsen at night and with rest. However, it is typically associated with other symptoms such as numbness and tingling.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Osteomyelitis or septic arthritis: Although less likely, these conditions can cause heel pain and must be considered, especially if the patient has a history of trauma, infection, or immunocompromised state.
- Bone tumor: A bone tumor, such as osteosarcoma, can cause heel pain and must be considered, especially if the patient has a history of cancer or unexplained weight loss.
- Rare diagnoses
- Paget's disease: This rare condition can cause bone pain, including heel pain, and is often associated with elevated alkaline phosphatase levels.
- Hypothyroidism: Some patients with hypothyroidism may experience muscle and joint pain, including heel pain, although this is a less common symptom.
- Vitamin B12 deficiency: A deficiency in vitamin B12 can cause a range of symptoms, including numbness and tingling in the feet, although heel pain is not a typical symptom. The patient's high MCV (mean corpuscular volume) may suggest a vitamin B12 deficiency.