Heel Pain: Or something else? Differential Diagnosis

Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99).

  • Foot deformities, e.g., flat foot (pes planus), high arch (pes cavus, pes excavatus).

Endocrine, nutritional and metabolic diseases (E00-E90).

  • Burning-feet syndrome (synonyms: burning-feet syndrome, Gopalan syndrome, Grierson-Gopalan syndrome); symptomatology: Painful burning sensation in the feet (in nocturnal attacks), often associated with paresthesias (numbness); etiology (cause) is unknown, hypovitaminosis (pantothenic acid, aneuric acid (vitamin B1) or nicotinic acid deficiency) or magnesium deficiency is suspected?
  • Hyperuricemia (uric acid metabolism disorder).

Cardiovascular system (I00-I99)

  • Erythromelalgia (EM; erythro = red, melos = limb, algos = pain) – acral circulatory disorder characterized by seizure-like redness and overheating of the skin on the extremities (hands/feet) associated with burning pain; vasodilation (dilation of blood vessels) provokes the overheating of the skin and painful redness here; disease is very rare
  • Ischemia (reduced blood flow) of the lower extremity (peripheral circulatory disorders).
  • Phlebitis (superficial phlebitis).
  • Thrombosis – complete or partial occlusion of a vessel by a thrombus (blood clot).

Infectious and parasitic diseases (A00-B99).

  • Warts
  • Tinea pedis (athlete’s foot)

Musculoskeletal system and connective tissue (M00-M99)

  • Achilles tendinopathy (Achilles tendinosis; achilles insertion tendinopathy; Achilles tendinopathy).
  • Apophysitis calcanei – disease of the growth plate of the calcaneus (calcaneal apophysis); symptomatology: pressure pain and swelling in the area of the growth plate of the calcaneus; disease peak 5-12 years of age; boys are more often affected than girls.
  • Osteoarthritis, subtalar (osteoarthritis of the lower ankle).
  • Bunion inflammation
  • Bursitis calcarea (bursitis)
  • Fasciitis plantaris (plantar fasciitis; plantar fasciitis) – inflammation of the fascial tissue of the sole of the foot (see below heel spur).
  • Gout (arthritis urica/uric acid-related joint inflammation or tophic gout): classic gout manifestation on the foot: podagra, i.e. arthrtis urica of the metatarsophalangeal joint of the big toe.
  • Heel pad pain: the heel pad is located directly under the os calcaneus (calcaneus).
  • Heel spur (calcaneal spur, calcaneal spur; plantar and dorsal calcaneal spur) – thorn-like exostosis (bone outgrowth, oriented toward the toes) of the calcaneus (heel bone).
  • Haglund deformity (Haglund heel) – bony form variant of the calcaneus with accentuated prominence of the proximal tuber calcanei (calcaneal tuberosity); painful swelling.
  • Reactive arthritis (Reiter’s disease) – special form of “reactive arthritis“. It is a secondary disease after gastrointestinal or urogenital infections, characterized by the symptomatology of Reiter’s triad.
  • Changes in the Achilles tendon such as irritation of the tendon / tendon attachment or bursitis (bursitis).

Neoplasms (C00-D48)

  • Neurinoma/schwannoma (slow-growing benign tumor of the peripheral nervous system arising from Schwann cells).
  • Tumor diseases of the calcaneus

Psyche – nervous system (F00-F99; G00-G99)

  • Baxter neuropathy – compression syndrome of the inferior calcaneal nerve at the heel, which can lead to chronic painful nerve damage; this form of neuropathy (peripheral nervous system disease) is responsible for approximately 5-20% of nerve pain; DD entrapment of the medial plantar nerve (“jogger’s nerve”).
  • S1 radiculopathy (damage to the nerve roots in the sacral region; S1 radiculopathy can lead to plantar fasciitis and gluteus maximus paresis/paralysis).

Injuries, poisonings, and other sequelae of external causes (S00-T98).

  • Muscle and tendon ruptures (rupture = tear).

Other causes

  • Tight shoes
  • Foreign body, unspecified