Differential Diagnosis for 67-year-old Female with Right Heel Pain and Swelling
Single Most Likely Diagnosis
- Plantar Fasciitis: This is the most common cause of heel pain in adults, especially in the elderly. The pain is usually worse in the morning and improves with activity. The absence of a remembered trauma history supports this diagnosis, as plantar fasciitis is often related to repetitive strain rather than acute injury.
Other Likely Diagnoses
- Achilles Tendinitis: Inflammation of the Achilles tendon can cause heel pain and swelling. This condition is common in older adults and can be related to overuse or degenerative changes.
- Heel Fat Pad Atrophy: As people age, the fat pad under the heel can atrophy, leading to pain and discomfort, especially when walking barefoot or on hard surfaces.
- Bursitis: Inflammation of the bursae around the heel can cause pain and swelling. This can be related to repetitive motion, poor footwear, or direct pressure on the heel.
Do Not Miss Diagnoses
- Calcaneal Fracture: Although the patient cannot remember a history of trauma, it's crucial to consider the possibility of an occult fracture, especially in older adults with osteoporosis. A fracture could lead to significant morbidity if not promptly diagnosed and treated.
- Infection (Osteomyelitis or Cellulitis): Infections in the foot can be serious, especially in diabetic or immunocompromised patients. Signs of infection, such as redness, warmth, and increased swelling, should be carefully evaluated.
- Tumor: Although rare, a tumor (benign or malignant) in the heel region could cause pain and swelling. A thorough examination and possibly imaging studies are necessary to rule out this possibility.
Rare Diagnoses
- Rheumatologic Conditions (e.g., Rheumatoid Arthritis, Psoriatic Arthritis): These conditions can cause heel pain and swelling but are less common causes compared to the aforementioned diagnoses.
- Seronegative Spondyloarthropathies: Conditions like ankylosing spondylitis or reactive arthritis can involve the heel, leading to pain and swelling, but are less likely in this age group without a previous diagnosis.
- Paget's Disease of Bone: A rare condition that can affect the calcaneus, leading to pain and deformity, but this would be an unusual presentation without other systemic symptoms or findings.