Differential Diagnosis for Horseshoe Pain around Heel
Single Most Likely Diagnosis
- Plantar Fasciitis: This condition is characterized by pain in the heel and bottom of the foot, often described as a horseshoe-shaped pain distribution. It typically improves with activity and worsens with rest, especially after periods of inactivity. The absence of a reported injury and the nature of the pain suggest plantar fasciitis as a leading diagnosis.
Other Likely Diagnoses
- Achilles Tendinosis: While this condition primarily affects the Achilles tendon, it can cause pain that radiates to the heel area. The pain from Achilles tendinosis can improve with walking as the tendon warms up but may worsen after rest. However, it's less likely than plantar fasciitis given the specific description of horseshoe pain.
- Heel Fat Pad Atrophy: This condition involves the loss of the fat pad under the heel, leading to pain upon weight-bearing and potentially worsening with rest due to increased pressure on the heel. It's a plausible diagnosis but less common than plantar fasciitis.
Do Not Miss Diagnoses
- Deep Vein Thrombosis (DVT): Although less likely given the description, DVT can cause leg pain that might be perceived as worsening with rest and improving with walking due to increased blood flow. It's crucial to consider DVT due to its potential for severe complications, such as pulmonary embolism.
- Osteomyelitis or Septic Arthritis: Infections of the bone or joint can cause severe pain that may seem to improve with movement and worsen with rest. These conditions are medical emergencies and must be ruled out, especially if there are systemic symptoms like fever.
Rare Diagnoses
- Tarsal Tunnel Syndrome: This condition involves compression of the posterior tibial nerve and can cause pain, numbness, and tingling in the heel and foot. While it's a possible cause of heel pain, it's less common and typically presents with additional neurological symptoms.
- Heel Stress Fracture: Although the patient reports no injury, stress fractures can occur without a specific incident, especially in individuals with risk factors like osteoporosis or those who have recently increased their physical activity. The pain from a stress fracture might improve with walking as the bone "warms up" but could worsen with rest.