What is the Differential Diagnosis of Heel Pain?

Dan Cavallari
Dan Cavallari

A differential diagnosis is essentially a process of elimination by which a health care professional can arrive at a diagnosis for a health problem. A differential diagnosis of heel pain will eliminate possibilities to find out what is causing the heel pain in a person. Plantar fasciitis, heel spurs, and heel fractures could all be the result of a differential diagnosis of heel pain. Since differential diagnosis is a process, a particular doctor may approach differential diagnosis of heel pain different than another doctor. Most physicians will work to eliminate life-threatening conditions first, then work through other possible diagnoses until only one possible diagnosis is left.

A doctor may perform a differential diagnosis of heel pain in the other direction: eliminating minor issues until only more severe issues are left. If all possibilities of a cause can be eliminated, then the doctor may conclude that he or she missed a potential cause, there may be no cause at all, or the pain may be caused by psychological issues. The latter case is not as rare as one might think, though a doctor can very often find a cause of the pain before reaching this conclusion.

Some of the more common causes of pain that will be included in a differential diagnosis of heel pain may include heel spurs and plantar fasciitis. These two conditions are closely linked and often mistaken for one another, making it difficult to determine which condition exists and which condition may have led to the other condition. A heel spur occurs when a bone deformity develops in the foot, causing pressure on nerves and soft tissue. Plantar fasciitis is the inflammation of the soft tissue of the foot, which can cause a person to change his or her gait, thereby placing pressure on places that would not otherwise receive such pressure. Both conditions can be quite painful, and the pain one experiences during either condition will be similar. An x-ray will be necessary to determine if a heel spur exists.

Fractures and sciatica are two more common causes of pain that will be addressed in a differential diagnosis of heel pain. Fractures occur when the bones endure a force that it is not prepared to handle, thereby leading to a small break in the bone. A fracture can be quite small, requiring rest and immobilization for healing, or it may be much more severe, requiring surgery to repair. Sciatica occurs when the sciatic nerve becomes compressed, thereby causing pain in the areas of the body it services, including the heel.

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