Differential Diagnosis for Heel Pain
Single Most Likely Diagnosis
- Plantar Fasciitis: This is the most common cause of heel pain, resulting from inflammation of the plantar fascia, a band of tissue that runs along the bottom of the foot. It is often associated with overuse, poor foot mechanics, or inadequate footwear.
Other Likely Diagnoses
- Achilles Tendinitis: Inflammation of the Achilles tendon, which connects the calf muscles to the heel bone, can cause heel pain, especially in individuals who engage in activities that involve running or jumping.
- Heel Spurs: A bony growth on the underside of the heel bone, which can cause pain when walking or standing, especially if the spur is large enough to irritate surrounding tissues.
- Bursitis: Inflammation of the bursae (fluid-filled sacs) at the back of the heel can cause pain and swelling, often due to repetitive motion or pressure on the heel.
- Fat Pad Atrophy: Thinning of the fat pad under the heel can lead to pain and discomfort, as the natural cushioning is reduced.
Do Not Miss Diagnoses
- Fracture: Although less common, a fracture of the heel bone (calcaneus) or stress fracture in the foot can cause significant heel pain and must be ruled out, especially in the context of trauma or sudden onset of pain.
- Infection: Osteomyelitis (bone infection) or septic arthritis (joint infection) in the foot or ankle can present with heel pain and is a medical emergency requiring prompt treatment.
- Tumor: Both benign and malignant tumors can occur in the heel, though they are rare, and their diagnosis is critical for appropriate management.
Rare Diagnoses
- Rheumatologic Conditions: Conditions like rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis can cause heel pain, though they are less common causes compared to the aforementioned diagnoses.
- Nerve Entrapment: Entrapment of nerves in the foot, such as the posterior tibial nerve, can lead to heel pain, though this is less common.
- Seronegative Spondyloarthropathies: Conditions such as reactive arthritis can cause heel pain and are important to consider in the differential diagnosis, especially in patients with a history of recent infection or certain genetic markers.