Differential Diagnosis for Bilateral Heel Pain when Walking
Single Most Likely Diagnosis
- Plantar Fasciitis: This is the most common cause of heel pain, especially when it occurs bilaterally. It is often associated with walking or standing and is due to inflammation of the plantar fascia, a band of tissue that supports the arch of the foot.
Other Likely Diagnoses
- Achilles Tendinitis: Inflammation of the Achilles tendon can cause pain in the back of the heel, which may be bilateral if the condition affects both tendons. It is common in runners or individuals who suddenly increase their physical activity.
- Heel Spurs: These are bony growths on the underside of the heel bone and can cause pain when walking, especially if they irritate the plantar fascia.
- Overuse or Repetitive Strain: Individuals who have recently increased their walking distance or frequency may experience bilateral heel pain due to overuse of the muscles and tendons in the foot.
- Poor Foot Mechanics: Abnormalities in the way the foot functions, such as flat feet or high arches, can lead to strain on the heel and surrounding tissues, causing pain.
Do Not Miss Diagnoses
- Osteomyelitis: Although rare, an infection of the bone in the heel can cause severe pain and is a medical emergency. It might not be the first consideration but is crucial not to miss due to its serious implications.
- Tumor: Both benign and malignant tumors can occur in the heel and cause pain. While rare, they are important to consider to ensure timely diagnosis and treatment.
- Seronegative Arthropathies: Conditions like reactive arthritis or psoriatic arthritis can cause heel pain and are important to diagnose due to their systemic implications and the need for specific treatment.
Rare Diagnoses
- Paget's Disease of Bone: A condition that affects bone remodeling, leading to weakened bones. It can cause pain in various parts of the body, including the heel, though this is less common.
- Bone Cysts: Fluid-filled areas within the bone can cause pain if they occur in the heel.
- Inflammatory Conditions: Certain inflammatory conditions, such as gout or rheumatoid arthritis, can less commonly present with heel pain but are important to consider for comprehensive diagnosis.