Differential Diagnosis
- Single most likely diagnosis
- Cellulitis: This is the most likely diagnosis given the presence of soft tissue swelling within the distal second and third toes without signs of subcutaneous gas deposition or focal bony lysis. The absence of radiographic signs of osteomyelitis and the maintenance of joint spacing also support this diagnosis.
- Other Likely diagnoses
- Soft tissue infection (e.g., abscess or phlegmon): These conditions could present with soft tissue swelling and would need to be considered in the differential diagnosis.
- Gout or pseudogout: Although the joint spacing is well-maintained, these conditions could still be considered, especially if the patient has a history of similar episodes.
- Trauma: A traumatic injury to the foot could result in soft tissue swelling and should be considered in the differential diagnosis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Necrotizing fasciitis: Although the absence of subcutaneous gas deposition makes this less likely, it is a potentially life-threatening condition that should not be missed.
- Septic arthritis: Although the joint spacing is well-maintained, septic arthritis is a serious condition that requires prompt diagnosis and treatment.
- Osteomyelitis (despite the radiographic impression): The radiographic impression notes no current signs of osteomyelitis, but this condition can be present even in the absence of radiographic findings, especially in the early stages.
- Rare diagnoses
- Erythromelalgia: A rare condition characterized by burning pain, heat, and redness in the hands and feet, which could potentially present with soft tissue swelling.
- Complex regional pain syndrome (CRPS): A rare condition characterized by chronic pain, swelling, and limited range of motion, which could potentially present with soft tissue swelling in the foot.