Differential Diagnosis for Heel Pain
- Single most likely diagnosis
- Achilles Tendinosis/Tendinitis: This condition is characterized by pain and inflammation in the Achilles tendon, which is located below the calf muscles and above the heel. The pain is typically worse with activities that involve dorsiflexion (upward movement of the foot) and better with rest and ice. The location of the pain below the Achilles tendon and the exacerbation with dorsiflexion strongly suggest this diagnosis.
- Other Likely diagnoses
- Haglund's Deformity: This condition involves a bony enlargement on the back of the heel that can cause pain, especially when the heel is subjected to pressure or when wearing certain types of shoes. While it doesn't directly relate to dorsiflexion, the pain location and potential for inflammation could align with the symptoms described.
- Retrocalcaneal Bursitis: Inflammation of the bursa that is located between the Achilles tendon and the heel bone (calcaneus) can cause pain in the area below the Achilles tendon. This condition can be exacerbated by activities that increase pressure on the bursa, such as dorsiflexion.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Tumor (e.g., Osteoid Osteoma): Although rare, a tumor in the heel or Achilles region could cause persistent pain that might not follow typical patterns of musculoskeletal pain. It's crucial to consider this possibility to ensure timely diagnosis and treatment.
- Infection (e.g., Osteomyelitis or Septic Bursitis): Infections in the bone or bursae around the heel can cause severe pain and have serious consequences if not promptly treated. While less common, these conditions necessitate immediate medical attention.
- Rare diagnoses
- Seronegative Spondyloarthropathies (e.g., Psoriatic Arthritis, Reactive Arthritis): These conditions can cause enthesitis, which is inflammation at the sites where tendons or ligaments insert into the bone, potentially leading to heel pain. They are less common causes of heel pain but should be considered, especially if other symptoms are present.
- Nerve Entrapment (e.g., Sural Nerve Entrapment): Compression or irritation of nerves in the heel area can cause pain. This is a less common cause of heel pain but could be considered if other diagnoses are ruled out.