Differential Diagnosis for Heel Pain Upon Waking
Single Most Likely Diagnosis
- Plantar Fasciitis: This condition is the most common cause of heel pain, especially when it occurs upon waking and improves as the day progresses. The plantar fascia, a band of tissue supporting the arch of the foot, becomes inflamed, leading to pain.
Other Likely Diagnoses
- Achilles Tendinitis: Inflammation of the Achilles tendon can cause heel pain, especially in individuals who are active in sports or activities that involve running or jumping. The pain often improves with activity as the tendon warms up.
- Heel Spur: A bony growth on the underside of the heel bone, which can cause pain when walking or standing, especially after periods of rest. The pain may decrease as the day goes on and the heel spur becomes less irritated.
- Fat Pad Atrophy: The fat pad under the heel can become thinner with age, reducing the cushioning effect and leading to pain, especially upon waking. The pain may improve as the fat pad becomes less compressed throughout the day.
Do Not Miss Diagnoses
- Infection (e.g., Osteomyelitis or Septic Arthritis): Although less common, infections in the foot or ankle can cause severe pain and must be promptly diagnosed and treated to prevent serious complications. The pain may not necessarily follow a specific pattern but can be severe and persistent.
- Tumor: Both benign and malignant tumors can occur in the heel, causing pain. While rare, it's crucial to consider this possibility to ensure early detection and treatment.
- Fracture: Stress fractures or other types of fractures in the heel can cause pain, especially upon weight-bearing activities. The pain pattern might not strictly follow improvement with activity but can be significant.
Rare Diagnoses
- Rheumatologic Conditions (e.g., Rheumatoid Arthritis, Psoriatic Arthritis): These conditions can cause heel pain among other symptoms. While less common as a primary presentation, they should be considered, especially if other systemic symptoms are present.
- Nerve Entrapment (e.g., Tarsal Tunnel Syndrome): Compression of nerves in the foot can lead to pain, numbness, and tingling. This condition might cause heel pain and is important to diagnose to relieve nerve compression.
- Paget's Disease of Bone: A chronic condition that can result in enlarged and misshapen bones, leading to pain. It's rare but should be considered in the differential diagnosis of heel pain, especially in older adults.