Plantar fasciitis — SCE Rheumatology MCQ

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EasyOsteoarthritis and Soft Tissue RheumatologyPlantar fasciitisSCE Rheumatology

A 50-year-old runner has heel pain worst with the first steps in the morning and after rest. Tenderness is maximal at the medial calcaneal tubercle. There is no Achilles swelling, no inflammatory back pain and CRP is normal. What is the most likely diagnosis?

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Correct answer: E — Plantar fasciitis

Explanation lettering: C = shown as A · D = shown as B · B = shown as C · A = shown as D

Plantar fasciitis is best because first-step heel pain with medial calcaneal tenderness is typical of plantar fasciitis. A is less suitable because calcaneal fracture follows trauma or stress injury with bony tenderness; B is less suitable because spondyloarthritis enthesitis would have inflammatory SpA features or Doppler enthesitis; C is less suitable because tarsal tunnel causes neuropathic plantar paraesthesia; D is less suitable because gout causes acute hot joint inflammation. Clinical pearl: heel pain is common; the pattern of first-step pain is diagnostically useful.

Reference: Oxford Textbook of Rheumatology