24 yr old woman walking up experiences pain in the heel which decreases on walking down. X-ray shows bone spur. Diagnosis
**Core Concept**
Heel pain is a common symptom that can be caused by various conditions affecting the foot, ankle, or lower leg. In this scenario, the pain that decreases with walking down is characteristic of a condition that involves the calcaneal (heel) region. The X-ray finding of a bone spur is a key clue in making a diagnosis.
**Why the Correct Answer is Right**
The pain in the heel that decreases with walking down is suggestive of retrocalcaneal bursitis, which is inflammation of the bursa located between the Achilles tendon and the calcaneus (heel bone). A bone spur, also known as a calcaneal exostosis, can cause irritation of the bursa, leading to pain and inflammation. The pain typically worsens with activities that involve heel rise, such as walking uphill.
**Why Each Wrong Option is Incorrect**
**Option A:** Achilles tendonitis is a possible cause of heel pain, but it typically worsens with activities that involve ankle flexion or dorsiflexion, not with walking downhill.
**Option B:** Plantar fasciitis is a common cause of heel pain, but it typically worsens with activities that involve toe push-off, not with walking downhill.
**Option C:** Stress fracture of the calcaneus can cause heel pain, but it is typically more severe with weight-bearing activities and may not be directly related to a bone spur.
**Clinical Pearl / High-Yield Fact**
Retrocalcaneal bursitis is often associated with a calcaneal bone spur, which can cause irritation of the bursa and lead to pain and inflammation. It is essential to consider this condition in the differential diagnosis of heel pain, especially in patients with a history of activities that involve heel rise.
**Correct Answer:** D.