Differential Diagnosis for Pain and Tenderness in the Back of Both Heels in a 66-Year-Old Woman
Single Most Likely Diagnosis
- Achilles Tendinitis: This condition is common in older adults and can cause pain and tenderness in the back of the heel due to inflammation of the Achilles tendon. The patient's age and the location of the pain make this a likely diagnosis.
Other Likely Diagnoses
- Plantar Fasciitis: Although this condition typically causes pain in the bottom of the heel, it can sometimes radiate to the back of the heel. Given its high prevalence, it remains a plausible cause.
- Bursitis: Inflammation of the bursae near the Achilles tendon can cause pain and swelling in the back of the heel, making it another possible diagnosis.
- Haglund's Deformity: A bony enlargement at the back of the heel can cause pain and tenderness, especially if it irritates the Achilles tendon or overlying soft tissues.
Do Not Miss Diagnoses
- Rheumatoid Arthritis: Although less common, rheumatoid arthritis can cause heel pain and should not be missed due to its potential for significant morbidity if left untreated.
- Gout: Gout can occasionally present with heel pain and is important to diagnose due to its potential for acute, severe pain and long-term joint damage.
- Infection (e.g., Cellulitis, Abscess): Infections in the heel area can be serious and require prompt antibiotic treatment. While less likely, they should not be overlooked.
- Tumor (e.g., Soft Tissue Sarcoma): Although rare, tumors can cause heel pain and are critical to diagnose early for effective treatment.
Rare Diagnoses
- Seronegative Spondyloarthropathies (e.g., Psoriatic Arthritis, Ankylosing Spondylitis): These conditions can cause heel pain but are less common and typically present with other systemic or musculoskeletal symptoms.
- Osteochondroma: A benign bone tumor that can cause pain if it presses on surrounding tissues, including the Achilles tendon.
- Paget's Disease of Bone: A condition that can cause bone pain, including in the heel, due to abnormal bone remodeling, though it's more commonly associated with other parts of the skeleton.