Differential Diagnosis for Heel Pain
The patient's symptoms of pain on the left back portion of the heel, similar to plantar fasciitis, and tenderness to pressure, require a thorough differential diagnosis. Here are the potential diagnoses categorized for clarity:
- Single Most Likely Diagnosis
- Plantar fasciitis: Given the patient's history of plantar fasciitis and the description of the pain, this is the most likely diagnosis. The condition often causes pain in the heel, especially with pressure, and can recur or affect the other heel.
- Other Likely Diagnoses
- Achilles tendinitis: This condition causes pain in the back of the heel and can be tender to the touch. It's a common issue in individuals who have experienced plantar fasciitis due to shared risk factors such as overuse or poor foot mechanics.
- Retrocalcaneal bursitis: Inflammation of the bursa that separates the Achilles tendon from the heel bone can cause pain and tenderness in the back of the heel, similar to the patient's symptoms.
- Haglund's deformity: A bony enlargement at the back of the heel bone can cause pain, especially if it irritates the Achilles tendon or the bursa, leading to symptoms similar to those described.
- Do Not Miss Diagnoses
- Osteomyelitis or bone infection: Although less common, an infection of the bone in the heel could present with pain and fever. Given the patient's history of fevers syndrome, it's crucial to consider infectious causes that could have serious consequences if missed.
- Tumor: A tumor in the heel, though rare, could cause persistent pain and should be considered to ensure timely diagnosis and treatment if present.
- Rare Diagnoses
- Seronegative spondyloarthropathy: Conditions like ankylosing spondylitis or reactive arthritis can cause heel pain due to enthesitis (inflammation where tendons or ligaments attach to bone). These are less common but should be considered, especially if there's a history of other symptoms like back pain or eye inflammation.
- Nerve entrapment: Entrapment of nerves in the foot or ankle, such as the sural nerve, could cause pain in the heel area, though this is less common than other causes of heel pain.