Differential Diagnosis for Medial Ankle Pain, Achilles Pain, and Heel Pain

Single Most Likely Diagnosis

• Achilles Tendinitis: This condition is characterized by inflammation of the Achilles tendon, leading to pain in the back of the ankle. Given the symptoms of Achilles pain and heel pain, Achilles tendinitis is a common and likely diagnosis due to overuse or repetitive strain on the tendon.

Other Likely Diagnoses

• Plantar Fasciitis: This condition involves inflammation of the plantar fascia, a band of tissue that runs along the bottom of the foot, causing heel pain. It's a common cause of heel pain and could contribute to medial ankle pain due to altered gait mechanics.
• Medial Ankle Sprain: Although less common than lateral ankle sprains, medial ankle sprains can occur, especially with eversion injuries, leading to medial ankle pain.
• Posterior Tibial Tendinitis: Inflammation of the posterior tibial tendon can cause pain in the medial ankle and foot, making it a plausible diagnosis for medial ankle pain.

Do Not Miss Diagnoses

• Deep Vein Thrombosis (DVT): Although DVT typically presents with swelling, redness, and warmth of the affected limb, it can sometimes cause pain in the calf or ankle area. Missing a DVT could be catastrophic due to the risk of pulmonary embolism.
• Osteomyelitis or Septic Arthritis: Infections of the bone or joint can cause severe pain, redness, and swelling. These conditions are medical emergencies requiring prompt treatment to prevent long-term damage.
• Tumor: Both benign and malignant tumors can cause pain in the ankle region. Although rare, missing a tumor could have significant implications for patient outcomes.

Rare Diagnoses

• 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, leading to pain, numbness, and tingling in the foot.
• Stress Fractures: Small cracks in the bones of the ankle or foot can cause pain, especially with activity. While not as common as other causes of ankle pain, stress fractures should be considered, especially in athletes or individuals with sudden increases in physical activity.
• Rheumatologic Conditions: Conditions like rheumatoid arthritis, psoriatic arthritis, or gout can cause ankle pain, including medial ankle pain and heel pain, due to inflammation of the joints.