{"id":6006,"date":"2025-05-07T12:01:04","date_gmt":"2025-05-07T20:01:04","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=6006"},"modified":"2025-10-01T11:38:25","modified_gmt":"2025-10-01T19:38:25","slug":"usmle-step-1-question-of-the-day-left-heel-pain","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-left-heel-pain","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day:\u00a0Left heel pain"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-left-heel-pain\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-left-heel-pain\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-left-heel-pain\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-left-heel-pain\/#Major_Takeaway\" >Major Takeaway&nbsp;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-left-heel-pain\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-left-heel-pain\/#References\" >References&nbsp;<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em><strong>Can you determine the most likely diagnosis for a 45-year-old woman presenting with left foot pain<\/strong><\/em><strong><em>? Let&#8217;s learn more about her case!<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 45-year-old woman comes to the office for evaluation of left foot pain. The patient recently joined a fitness program that requires her to walk two to three miles daily. The pain begins with her first steps and worsens throughout her daily walks. The pain improves with rest and does not recur with normal daily activities. Past medical history is significant for type 2 diabetes mellitus. Current medications include metformin and atorvastatin. Vitals are within normal limits. Physical examination shows a normal left and right foot arch. Direct pressure applied to the bottom of the left heel elicits a sharp pain. Mediolateral squeezing of the heels does not elicit pain. There is tenderness to palpation between the left heel and forefoot when the left toes are dorsiflexed. The remainder of the bilateral lower extremity examination is unremarkable. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em>Which of the following is the most likely cause of this patient\u2019s condition?&nbsp;<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Entrapment of the posterior tibial nerve<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Neuropathic degeneration of interdigital nerves<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Inflammation and degeneration of the plantar aponeurosis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Overuse injury of the calcaneus<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Neurogenic arthropathy<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Inflammation and degeneration of the plantar aponeurosis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Correct:<\/strong> See Main Explanation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Entrapment of the posterior tibial nerve<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Injury or compression of the posterior tibial nerve at the tarsal tunnel may result in numbness or paraesthesias over the sole of the foot. Pain is reproduced with percussion of the tarsal tunnel (Tinel sign) and not by the palpation of the heel.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Neuropathic degeneration of interdigital nerves<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Neuropathic degeneration of interdigital nerves can result in a Morton neuroma, which presents with pain between the third and fourth toes on the plantar surface and a clicking sensation upon squeezing the metatarsal joints. Tenderness of the heel with dorsiflexion of the toes is typical of plantar fasciitis.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Overuse injury of the calcaneus<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Calcaneal stress fractures can occur following the initiation of high-impact exercise programs or overuse. It causes pain at the heel that worsens with weight bearing. Pain is often elicited by firm palpation at the lateral and medial aspect of the heel. Tenderness of the heel reproduced on dorsiflexion of toes is more typical for plantar fasciitis.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Neurogenic arthropathy<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Neurogenic arthropathy (charcot joint) presents with deformity and sensory deficits of the foot due to trauma, secondary to impaired proprioception and pain sensations. Therefore, pain is typically mild in these patients.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"975\" height=\"724\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/05\/image_40a600.png\" alt=\"Plantar Fasciitis\nHeel Bone (Calcaneus)\nArea of Pain (in the arch of foot)\nPlantar fascia\" class=\"wp-image-6008\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/05\/image_40a600.png 975w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/05\/image_40a600.png?resize=300,223 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/05\/image_40a600.png?resize=768,570 768w\" sizes=\"auto, (max-width: 975px) 100vw, 975px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">This patient\u2019s heel pain is most likely due to the inflammation and degeneration of plantar aponeurosis, resulting in plantar fasciitis.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Plantar aponeurosis is a thick fibrous band that extends from the calcaneus of the foot to the toes, which functions to support the longitudinal arch of the foot. Plantar fasciitis results from chronic overuse and repetitive trauma to aponeurosis near its insertion point at the calcaneus. Risk factors include obesity, excessive foot pronation, excessive running, and prolonged standing. Patients typically present with stabbing heel pain that worsens with walking and may worsen after activity or at the end of the day. Physical examination often demonstrates tenderness at the insertion of the plantar fascia on the calcaneus, especially with toe dorsiflexion.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The diagnosis is based on clinical findings, but plain radiographs may reveal heel spurs, which are of little diagnostic significance. Plantar fasciitis is a self-limited condition with most resolution of symptoms within twelve months. Initial treatment consists of ice, heat, massage, stretching, and elimination of exacerbating activities.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Plantar fasciitis results from inflammation and degeneration of plantar aponeurosis, secondary to chronic overuse and repetitive trauma at its insertion site. Patients typically present with sharp and stabbing heel pain that worsens with ambulation. Physical examination demonstrates tenderness at the insertion point of the plantar fascia on the calcaneus, especially with toe dorsiflexion.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Read this Osmosis Answer page:&nbsp;<a href=\"https:\/\/www.osmosis.org\/answers\/plantar-fasciitis\">Plantar Fasciitis<\/a><\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Langford C.A. (2018). Periarticular disorders of the extremities. Jameson J, &amp; Fauci A.S., &amp; Kasper D.L., &amp; Hauser S.L., &amp; Longo D.L., &amp; Loscalzo J(Eds.), Harrison&#8217;s Principles of Internal Medicine, 20e. McGraw-Hill.<\/li>\n\n\n\n<li>Gollotto K, &amp; Rosero E, &amp; Connor C, &amp; Hezel J (2014). Sports rehabilitation. Maitin I.B., &amp; Cruz E(Eds.), CURRENT Diagnosis &amp; Treatment: Physical Medicine &amp; Rehabilitation. McGraw-Hill.<\/li>\n\n\n\n<li>Goff, J. D., &amp; Crawford, R. (2011). Diagnosis and treatment of plantar fasciitis. American family physician, 84(6), 676-682.&nbsp;<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/mobile-app\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2021\/02\/Blog_Display_Ads_MOBILE1_2023.png?w=700\" alt=\"\" class=\"wp-image-4531\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2021\/02\/Blog_Display_Ads_MOBILE1_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2021\/02\/Blog_Display_Ads_MOBILE1_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more USMLE\u00ae Step 1 practice questions? Try Osmosis by Elsevier today! Access your&nbsp;<em><strong><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/strong><\/em>&nbsp;and discover why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Explore today&#8217;s USMLE\u00ae Step 1 question focusing on left heel pain to enhance your diagnostic skills!<\/p>\n","protected":false},"author":202,"featured_media":6009,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,16,1366,1369,44],"tags":[595,265,726,84,727,148,728,149,725,185],"class_list":["post-6006","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-questions","category-step-1-questions","category-step-1","tag-diagnosis","tag-healthcare-training","tag-heel-pain","tag-medical-education","tag-medical-questions","tag-medical-training","tag-orthopedic-health","tag-patient-care","tag-plantar-fasciitis","tag-usmle"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - 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Dive into the details and sharpen your clinical skills for effective patient care!","rel":"","context":"In &quot;Allopathic Medicine (MD)&quot;","block_context":{"text":"Allopathic Medicine (MD)","link":"https:\/\/www.osmosis.org\/blog\/category\/medicine"},"img":{"alt_text":"Step 2 CK Question of the Day Leg pain","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Step_2_CK_Question-of-the-day-leg-pain.jpg","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Step_2_CK_Question-of-the-day-leg-pain.jpg 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Step_2_CK_Question-of-the-day-leg-pain.jpg 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Step_2_CK_Question-of-the-day-leg-pain.jpg 2x"},"classes":[]},{"id":3336,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-bilateral-pitting-ankle-edema","url_meta":{"origin":6006,"position":5},"title":"USMLE\u00ae Step 1 Question of the Day: Bilateral Pitting Ankle Edema","author":"Marina Horiates Kerekes, MD &amp; Team","date":"March 31, 2021","format":false,"excerpt":"Each week, Osmosis shares a USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics. Today's case involves a 38-year-old woman with pain in the center of her chest. The pain is slightly better when she sits up straight. Physical examination shows conjunctival pallor and bilateral pitting ankle\u2026","rel":"","context":"In &quot;Allopathic Medicine (MD)&quot;","block_context":{"text":"Allopathic Medicine (MD)","link":"https:\/\/www.osmosis.org\/blog\/category\/medicine"},"img":{"alt_text":"USMLE\u00ae Step 1 Question of the Day: Bilateral Pitting Ankle Edema","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-18T112652.031.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-18T112652.031.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-18T112652.031.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-18T112652.031.webp 2x"},"classes":[]}],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/6006","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/users\/202"}],"replies":[{"embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/comments?post=6006"}],"version-history":[{"count":3,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/6006\/revisions"}],"predecessor-version":[{"id":6841,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/6006\/revisions\/6841"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/media\/6009"}],"wp:attachment":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/media?parent=6006"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/categories?post=6006"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/tags?post=6006"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}