Differential Diagnosis for End of the Day Heel Pain

• Single Most Likely Diagnosis
  • Plantar Fasciitis: This condition is the most common cause of heel pain, especially at the end of the day. It is characterized by inflammation of the plantar fascia, a band of tissue that runs along the bottom of the foot, supporting the arch. The pain typically worsens after periods of rest or at the end of the day due to increased stress on the plantar fascia throughout the day.
• Other Likely Diagnoses
  • Achilles Tendinitis: Inflammation of the Achilles tendon, which connects the calf muscles to the heel bone, can cause pain in the back of the heel. This condition is common in runners and individuals who engage in activities that involve repetitive ankle motion.
  • Heel Spurs: These are bony growths on the underside of the heel bone. While they may not always cause symptoms, heel spurs can lead to pain when they irritate the surrounding tissue, including the plantar fascia.
  • Fat Pad Atrophy: The fat pad under the heel can become thinner with age or due to repetitive stress, leading to less cushioning and increased pressure on the heel bone, resulting in pain.
• Do Not Miss Diagnoses
  • Tumor (e.g., Osteoid Osteoma): Although rare, a tumor in the heel can cause persistent pain. Missing this diagnosis could lead to delayed treatment and potentially serious consequences.
  • Infection (e.g., Osteomyelitis): An infection of the bone in the heel can cause severe pain and is a medical emergency. Prompt diagnosis and treatment are crucial to prevent serious complications.
  • Fracture: A stress fracture or other type of fracture in the heel can cause pain that worsens over time. Missing this diagnosis could lead to further injury and prolonged recovery.
• Rare Diagnoses
  • Rheumatoid Arthritis: This autoimmune disorder can cause inflammation and pain in various parts of the body, including the heel. While less common as a primary cause of heel pain, it should be considered in patients with a history of rheumatoid arthritis.
  • Seronegative Spondyloarthropathies (e.g., Psoriatic Arthritis, Ankylosing Spondylitis): These conditions can cause heel pain due to enthesitis, inflammation where tendons and ligaments attach to bone. They are less common causes of heel pain but important to consider in patients with relevant systemic symptoms.