Differential Diagnosis for Heel Pain

The patient's symptoms of pain in the heel region, particularly over the lateral superior aspect of the calcaneus bone, following the initiation of running and jumping exercises, suggest several potential causes. The differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis

  • Peroneal Tendinitis/Tendinosis: This condition is likely given the patient's recent increase in running and jumping activities, which can put additional stress on the peroneal tendons. The tenderness over the lateral superior aspect of the calcaneus bone, where the peroneal tendons are located, further supports this diagnosis. Treatment may include rest, physical therapy, and possibly orthotics to reduce stress on the tendons.

• Other Likely Diagnoses

  • Lateral Plantar Fasciitis: Although the patient's tenderness is more lateral, plantar fasciitis can sometimes present with lateral heel pain, especially if the patient has a varus foot alignment or has recently changed their exercise routine. Treatment involves stretching, orthotics, and possibly steroid injections.
  • Bursitis of the Lateral Calcaneus: Inflammation of the bursa located near the lateral aspect of the calcaneus can cause pain and tenderness in this area, especially with activities that increase pressure on this bursa. Treatment may include rest, ice, compression, and elevation (RICE), along with anti-inflammatory medications.
  • Stress Fracture of the Calcaneus: While less common, a stress fracture should be considered, especially in athletes who have recently increased their training intensity or changed their training surface. The diagnosis is typically made with imaging studies. Treatment involves rest and possibly immobilization.

• Do Not Miss Diagnoses

  • Infection (Osteomyelitis or Septic Arthritis): Although rare, infection in the heel region can be serious and requires prompt diagnosis and treatment. Symptoms might include increased redness, warmth, swelling, and fever. Diagnostic workup would include blood tests and imaging.
  • Tumor: Both benign and malignant tumors can cause heel pain. A thorough history and physical examination, along with imaging studies, are crucial for diagnosis. Treatment depends on the type of tumor.

• Rare Diagnoses

  • Haglund’s Deformity: This condition involves a bony enlargement on the back of the heel that can cause pain, especially with tight Achilles tendons or certain types of shoes. While it could potentially cause lateral heel pain if the deformity affects the lateral aspect of the calcaneus, it's less likely given the specific location of tenderness.
  • Entrapment of the Sural Nerve: This nerve runs down the lateral aspect of the leg and can be entrapped near the heel, causing pain. However, this condition is less common and would typically present with additional neurological symptoms such as numbness or tingling.