Differential Diagnosis for Mid Foot Arch Pain
The patient's history and symptoms suggest a range of possible diagnoses. Here is a categorized list of potential diagnoses:
- Single most likely diagnosis
- Plantar Fascia Tear or Rupture: The patient's history of a "pop" in the mid foot arch region, followed by immediate pain and limping, is highly suggestive of a plantar fascia tear or rupture. The pain and numbness extending into the hind foot on the plantar surface also support this diagnosis.
- Other Likely diagnoses
- Peroneal Tendonitis: The patient's pain in the mid foot arch region could be related to peroneal tendonitis, especially given the history of playing with his son and potentially overusing the tendons.
- Midfoot Sprain: A sprain in the midfoot region could also cause pain and numbness, especially if the patient experienced a sudden twisting or bending injury.
- Orthotic-Related Issues: Although the patient is already wearing custom orthotics, it's possible that the orthotics are not adequately addressing the patient's foot mechanics, leading to ongoing pain and numbness.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Compartment Syndrome: Although less likely, compartment syndrome is a potentially deadly condition that requires prompt diagnosis and treatment. The patient's severe pain and numbness could be indicative of compartment syndrome, especially if there is associated swelling, pallor, or pulselessness.
- Deep Vein Thrombosis (DVT): DVT is another potentially deadly condition that could cause pain and numbness in the foot and ankle region. Although less likely, it's essential to consider DVT in the differential diagnosis, especially if the patient has a history of blood clots or other risk factors.
- Rare diagnoses
- Tarsal Tunnel Syndrome: This condition involves compression of the posterior tibial nerve as it passes through the tarsal tunnel, leading to pain, numbness, and tingling in the foot and ankle region.
- Stress Fracture: A stress fracture in the midfoot region could cause pain and numbness, especially if the patient has a history of overuse or repetitive stress injuries.