Differential Diagnosis for Pain in Medial Aspect of Calcaneus Bone on Weight Bearing

• Single most likely diagnosis
  • Plantar fasciitis: This condition is the most common cause of heel pain, especially on the medial aspect of the calcaneus. It occurs due to inflammation of the plantar fascia, a band of tissue that supports the arch of the foot. Weight-bearing activities exacerbate the pain, making it a likely diagnosis for pain in the medial calcaneus on weight bearing.
• Other Likely diagnoses
  • Calcaneal stress fracture: Stress fractures are small cracks in a bone, often caused by overuse or repetitive stress. The calcaneus is a common site for stress fractures, which can cause pain on the medial aspect, especially with weight-bearing activities.
  • Fat pad atrophy: The fat pad under the heel can become thinner with age or due to certain conditions, leading to less cushioning and increased pressure on the calcaneus, causing pain.
  • Tarsal tunnel syndrome: This condition involves compression of the posterior tibial nerve as it travels through the tarsal tunnel on the inner side of the ankle. It can cause pain, numbness, and tingling in the foot, including the medial aspect of the calcaneus.
• Do Not Miss diagnoses
  • Osteomyelitis: Although rare, osteomyelitis (bone infection) of the calcaneus can cause severe pain, especially with weight bearing. It is crucial to consider this diagnosis to initiate appropriate treatment and prevent serious complications.
  • Bone tumor: Tumors such as osteoid osteoma or other benign/malignant lesions can cause localized pain in the calcaneus. Early detection is vital for effective management.
• Rare diagnoses
  • Haglund's deformity: This condition involves a bony enlargement on the back of the heel, which can cause pain, especially if it irritates the Achilles tendon or surrounding tissues.
  • Inflammatory arthritis: Conditions like rheumatoid arthritis or seronegative spondyloarthropathies can cause heel pain, including pain on the medial aspect of the calcaneus, though this is less common compared to other symptoms.