Differential Diagnosis for Heel Pain

The following is a list of potential diagnoses for heel pain, categorized by likelihood and potential impact.

• Single Most Likely Diagnosis

  • Plantar fasciitis: This is the most common cause of heel pain, resulting from inflammation of the plantar fascia, a band of tissue that supports the arch of the foot. It is often associated with overuse, poor foot mechanics, or inadequate footwear.

• Other Likely Diagnoses

  • Achilles tendinitis: Inflammation of the Achilles tendon, which connects the calf muscles to the heel bone, can cause heel pain, especially with activities that involve running or jumping.
  • Heel spur: A bony growth on the underside of the heel bone, which can cause pain when walking or standing.
  • Bursitis: Inflammation of the fluid-filled sacs (bursae) that cushion the joints and reduce friction between bone and soft tissue can lead to heel pain.
  • Fat pad atrophy: Thinning of the fat pad under the heel can cause pain, especially in older adults.

• Do Not Miss Diagnoses

  • Calcaneal stress fracture: A small crack in the heel bone, which can be caused by overuse or repetitive stress, and may not be immediately apparent on X-rays.
  • Tumor (e.g., osteoid osteoma): Although rare, a tumor in the heel can cause persistent pain and should not be overlooked.
  • Infection (e.g., osteomyelitis, septic arthritis): Infections in the bone or joint can cause severe heel pain and require prompt medical attention.
  • Peripheral artery disease: Reduced blood flow to the feet can cause pain in the heel, especially when walking.

• Rare Diagnoses

  • Haglund's deformity: A bony growth on the back of the heel bone, which can cause pain and inflammation.
  • Retrocalcaneal bursitis: Inflammation of the bursa that separates the Achilles tendon from the heel bone.
  • Seronegative spondyloarthropathy (e.g., psoriatic arthritis, reactive arthritis): Certain types of arthritis can cause heel pain, although this is less common.
  • Nerve entrapment (e.g., tarsal tunnel syndrome): Compression of the nerves in the foot can cause pain, numbness, and tingling in the heel.