Differential Diagnosis for Foot Calcaneal Medial Tubercle Pain

Single Most Likely Diagnosis

• Plantar Fasciitis: This condition is the most common cause of heel pain, especially in the medial tubercle area. It is characterized by inflammation of the plantar fascia, which runs along the bottom of the foot and supports the arch. The pain is typically worse with walking, especially after periods of rest, and is common in individuals who are overweight, have flat feet, or wear shoes with inadequate support.

Other Likely Diagnoses

• Heel Spur: A heel spur is a bony growth that can develop on the underside of the heel bone, often associated with plantar fasciitis. It can cause pain when walking, especially if the spur is large enough to irritate surrounding tissues.
• Achilles Tendinitis: Although this condition primarily affects the back of the heel, severe cases can refer pain to the medial aspect of the heel, especially if the tendon's insertion is involved.
• Fat Pad Atrophy: The fat pad under the heel can become thinner with age, reducing the natural cushioning and leading to pain, especially on the medial tubercle when walking.

Do Not Miss Diagnoses

• Calcaneal Stress Fracture: A stress fracture in the calcaneus can cause severe pain, especially with weight-bearing activities. Missing this diagnosis could lead to further bone weakening and potentially a more serious fracture.
• Tumor (e.g., Osteoid Osteoma): Although rare, a tumor in the calcaneus could cause localized pain that worsens with activity. Missing a diagnosis of a tumor could have significant implications for treatment and prognosis.
• Infection (e.g., Osteomyelitis): An infection of the bone in the heel area could cause pain, redness, and swelling. This condition requires prompt antibiotic treatment to prevent serious complications.

Rare Diagnoses

• Seronegative Spondyloarthropathies (e.g., Psoriatic Arthritis, Reactive Arthritis): These conditions can cause heel pain due to enthesitis (inflammation where tendons or ligaments insert into the bone). They are less common causes of heel pain but should be considered, especially in patients with a history of psoriasis or recent gastrointestinal or genitourinary infections.
• Paget's Disease of Bone: This condition involves an abnormal breakdown and regrowth of bone tissue, leading to deformity. It can cause pain in the affected bones, including the calcaneus, though it is a rare cause of heel pain.