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, small fluid-filled sacs that cushion bones, tendons, and muscles near joints, can lead to heel pain if the bursae near the heel become inflamed.
- Fat Pad Atrophy: Thinning of the fat pad under the heel can lead to pain due to reduced cushioning and increased pressure on the heel bone.
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 considered, 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.
- Tumor: Both benign and malignant tumors can occur in the heel, though they are rare, and their diagnosis is critical for appropriate management.
- Peripheral Artery Disease (PAD): PAD can cause pain in the heel and foot, especially during exercise, due to reduced blood flow.
Rare Diagnoses
- Rheumatologic Conditions: Conditions like rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis can cause heel pain, though they are less common causes.
- Nerve Entrapment: Entrapment of nerves in the foot, such as the posterior tibial nerve, can lead to heel pain.
- Paget's Disease: A chronic bone disorder that can result in enlarged and misshapen bones, potentially causing heel pain if the heel bone is affected.
- Osteonecrosis: Death of bone tissue due to a lack of blood supply, which can occur in the heel bone and cause pain.