Differential Diagnosis for Intermittent Left Heel Pain
- Single most likely diagnosis
- Plantar Fasciitis: This condition is characterized by pain in the heel and bottom of the foot, often associated with a hard, callous-like bump. The pain typically worsens with activities that stretch or tear the plantar fascia, such as ankle flexion and extension. The intermittent nature of the pain and its tendency to subside after a few days also align with plantar fasciitis.
- Other Likely diagnoses
- Achilles Tendinosis: This condition involves inflammation and degeneration of the Achilles tendon, which can cause pain in the posterior heel, especially with ankle flexion and extension. The presence of a hard, callous-like bump could be related to the formation of a Haglund's deformity, often seen in Achilles tendinosis.
- Haglund's Deformity: A bony enlargement on the posterior heel that can cause pain, especially when the Achilles tendon is inflamed or irritated. The hard callous-like bump described could be a sign of this condition.
- Bursitis: Inflammation of the bursae around the heel can cause pain and swelling, potentially leading to the formation of a hard bump. Activities like ankle flexion and extension can exacerbate bursitis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Tumor (e.g., Osteoid Osteoma): Although rare, a tumor in the heel could cause intermittent pain and a palpable mass. Missing this diagnosis could have severe consequences, including delayed treatment and potential metastasis.
- Infection (e.g., Osteomyelitis): An infection of the bone in the heel could cause pain, swelling, and the formation of a hard bump. This condition requires prompt antibiotic treatment to prevent serious complications.
- Rare diagnoses
- Seronegative Spondyloarthropathy (e.g., Psoriatic Arthritis, Reactive Arthritis): These conditions can cause heel pain and enthesitis (inflammation at the site where tendons or ligaments insert into the bone), potentially leading to the formation of a hard bump.
- Stress Fracture: A small crack in one of the bones in the heel could cause intermittent pain, especially with weight-bearing activities. Although less common, a stress fracture should be considered, especially if the patient has recently increased their physical activity.