Differential Diagnosis for Heel Pain

The following is a list of potential causes for the stabbing pain at the bottom of the heel, categorized for clarity and urgency.

• Single most likely diagnosis

  • Plantar Fasciitis: This condition is the most common cause of heel pain, characterized by inflammation of the plantar fascia, a band of tissue that runs along the bottom of the foot. The stabbing pain, especially after periods of rest or at the beginning of the day, is a hallmark symptom.

• Other Likely diagnoses

  • Heel Spur: A bony growth on the underside of the heel bone, which can cause pain when it irritates the plantar fascia or the surrounding tissue.
  • Fat Pad Atrophy: The loss of the fatty tissue under the heel can lead to pain due to the reduced cushioning effect.
  • Achilles Tendinitis: Although the pain is typically at the back of the heel, severe cases can radiate to the bottom, especially if the condition progresses to involve the insertion of the tendon on the calcaneus.
  • Overuse or Repetitive Strain: Activities that involve running, dancing, or any repetitive impact on the heel can lead to pain due to strain on the muscles and tendons supporting the heel.

• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)

  • Osteomyelitis: A bone infection that can cause severe pain, redness, and swelling. It's less common but critical to diagnose early due to the potential for serious complications.
  • Tumor (Benign or Malignant): Although rare, tumors in the heel can cause persistent pain and should be considered, especially if the pain is constant, worsening, or accompanied by other systemic symptoms like weight loss or fever.
  • Deep Vein Thrombosis (DVT): While DVT typically presents with swelling and pain in the calf, in rare cases, it can cause pain in the heel due to the involvement of the deep veins in the foot.

• Rare diagnoses

  • Tarsal Tunnel Syndrome: Compression of the posterior tibial nerve as it travels through the tarsal tunnel on the inner side of the ankle can cause pain, numbness, and tingling in the heel and foot.
  • Baxter's Neuroma: Entrapment of the inferior calcaneal nerve can cause pain in the heel, similar to but less common than plantar fasciitis.
  • Inflammatory Arthritis: Conditions like rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis can cause heel pain, though this is less common and usually part of a broader symptom complex.