Differential Diagnosis for Heel Pain

• 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 runs along the bottom 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 in individuals who engage in 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 (ddxs that may not be likely, but would be deadly if missed.)
  • Osteomyelitis: A bone infection that can cause heel pain, redness, and swelling. It requires prompt antibiotic treatment to prevent serious complications.
  • Tumor: Although rare, tumors such as osteoid osteoma or Ewing's sarcoma can cause heel pain and should not be missed.
  • Fracture: A stress fracture or other types of fractures in the heel can cause severe pain and require immediate medical attention.
• Rare diagnoses
  • Rheumatoid arthritis: An autoimmune disorder that can cause heel pain, stiffness, and swelling, especially in the morning.
  • Gout: A form of arthritis characterized by sudden, severe attacks of pain, swelling, and redness, which can occur in the heel.
  • Nerve entrapment: Compression or irritation of the nerves in the foot can cause heel pain, numbness, or tingling.
  • Infection: Cellulitis, abscess, or other infections can cause heel pain, redness, and swelling, and require prompt medical attention.