Differential Diagnosis for Pain in Centre of Plantar Heel

• Single most likely diagnosis
  • Plantar fasciitis: This condition is the most common cause of heel pain and is often exacerbated by weight-bearing activities, especially after a traumatic event like standing on a rock. The pain typically improves with rest, which aligns with the symptoms described.
• Other Likely diagnoses
  • Fat pad atrophy or inflammation: The fat pad under the heel can become inflamed or atrophied, leading to pain, especially with weight-bearing. This condition could be worsened by standing on a hard object like a rock.
  • Heel bruise (contusion): Direct trauma to the heel, such as standing on a rock, can cause a bruise, leading to pain that worsens with weight-bearing and improves with rest.
  • Calcaneal stress fracture: Although less common, a stress fracture in the calcaneus (heel bone) could be caused by repetitive stress or a sudden traumatic event and would cause pain that worsens with weight-bearing.
• Do Not Miss diagnoses
  • Osteomyelitis or septic arthritis: Although rare, infections in the bone or joint of the heel can cause severe pain and have serious consequences if not promptly treated. These conditions might not initially present with systemic symptoms like fever.
  • Tumor: A tumor in the heel, whether benign or malignant, could cause pain, especially if it is in a weight-bearing area. This would be a rare cause but is critical not to miss due to the potential for serious disease.
• Rare diagnoses
  • Entrapment of the medial calcaneal nerve: This is a rare cause of heel pain and would typically present with more specific neurological symptoms, but it could be considered in the differential diagnosis if other causes are ruled out.
  • Inflammatory arthropathies (e.g., rheumatoid arthritis, psoriatic arthritis): These conditions can cause heel pain but are usually accompanied by other systemic or joint symptoms. They would be less likely without additional symptoms but should be considered if the pain does not respond to typical treatments for more common causes.