Differential Diagnosis for a Bump on the Heel in a 14-Year-Old Male Hockey Player
Single Most Likely Diagnosis
- Sever's Disease (Calcaneal Apophysitis): This condition is the most common cause of heel pain in adolescents, particularly in those involved in sports that include running or jumping, such as hockey. It is an inflammatory condition of the growth plate in the calcaneus (heel bone) and typically presents as pain and swelling in the heel.
Other Likely Diagnoses
- Plantar Fasciitis: Although more common in adults, plantar fasciitis can occur in adolescents, especially those who are active in sports. It involves inflammation of the plantar fascia, leading to pain in the heel and bottom of the foot.
- Heel Contusion or Bruise: Given the physical nature of hockey, a direct blow to the heel could result in a contusion or bruise, presenting as a bump and pain.
- Achilles Tendinitis: Inflammation of the Achilles tendon, which connects the calf muscles to the heel bone, can cause pain and swelling at the back of the heel.
Do Not Miss Diagnoses
- Osteomyelitis: Although rare, osteomyelitis (bone infection) is a serious condition that requires prompt treatment. It can present with pain, swelling, and redness, and a bump could be part of the clinical presentation.
- Bone Tumor: Tumors such as osteosarcoma or Ewing's sarcoma, though rare, can present with a lump or bump and are critical to diagnose early for effective treatment.
Rare Diagnoses
- Haglund's Deformity: A bony growth on the back of the heel bone, which can cause pain and swelling, especially if it irritates the Achilles tendon.
- Bursitis: Inflammation of a bursa (fluid-filled sac) near the heel can cause swelling and pain, and could potentially present as a bump.
- Stress Fracture: A small crack in the bone, often caused by overuse, can lead to pain and swelling, and might be considered if other diagnoses are ruled out and the patient continues to experience pain.