Differential Diagnosis for 63-year-old Female with Right Foot Pain
Single Most Likely Diagnosis
- Morton's Neuroma: This condition is characterized by pain in the dorsal aspect of the foot, particularly underneath the phalanges, which is exacerbated by ambulation and relieved by rest. The symptoms described match closely with Morton's Neuroma, making it the most likely diagnosis.
Other Likely Diagnoses
- Plantar Fasciitis: Although the pain is described as being on the dorsal aspect, some cases of plantar fasciitis can refer pain to this area. The increased pain with ambulation is consistent with this diagnosis.
- Metatarsalgia: This condition involves pain in the metatarsal area, which could radiate to the dorsal aspect of the foot. It is often associated with activities that increase pressure on the metatarsals, such as walking.
- Gout or Pseudogout: These conditions can cause sudden, severe pain in the foot, often accompanied by swelling. While the pain pattern might not perfectly match, the possibility of these conditions should be considered, especially given the patient's age.
Do Not Miss Diagnoses
- Deep Vein Thrombosis (DVT): Although less common in the foot, DVT can cause pain and swelling. Given the potential severity of this condition (e.g., pulmonary embolism), it's crucial not to miss it, despite its lower likelihood.
- Osteomyelitis or Septic Arthritis: Infections in the bone or joint can cause pain, swelling, and increased pain with movement. These conditions are medical emergencies and must be ruled out.
- Peripheral Artery Disease (PAD): This condition can cause pain in the feet during exercise (intermittent claudication) due to inadequate blood flow. While the description doesn't perfectly fit, PAD is a significant condition that should not be overlooked.
Rare Diagnoses
- Erythromelalgia: A rare disorder characterized by burning pain, heat, and redness in the hands and feet. It could potentially cause the described symptoms, although it is much less common.
- Complex Regional Pain Syndrome (CRPS): A condition characterized by intense burning or aching pain in the hands or feet after an injury or trauma. The symptoms can include swelling and changes in skin temperature and color.
- Tarsal Tunnel Syndrome: Similar to carpal tunnel syndrome but affecting the foot, this condition involves compression of the posterior tibial nerve, leading to pain and numbness in the foot.