Differentialdiagnose dorsaler Fersenschmerz

Abstract

Heel pain is a common complaint with a prevalence of 15%. Besides inflammatory, infectious, neuropathic or tumor associated causes of pain, a mechanical bony or soft-tissue related disorder can be identified in most cases. Implementing a successful therapy can be challenging due to the variety of clinically similar differential diagnoses. Degenerative pathologies of the Achilles tendon frequently cause posterior heel pain and are subdivided into insertional tendinopathy (often associated with dorsal heel spurs) and mid portion tendinopathy, which is situated in a hypovascular ”critical zone” 2 to 6cm proximal to the calcaneal insertion site. Other typical disorders causing dorsal heel pain are retro-calcaneal or retro-Achilles bursitis, bony deformities (Haglund́s Syndrome), accessory ossicles (Os trigonum), calcaneal apophysitis (Severˊs disease) or flexor hallucis longus entrapment. A thorough physical examination and imaging diagnostics with sonography and MRI are crucial to identify the cause of pain. The therapy includes a wide range of conservative and surgical options depending on the main pathology.