Differential Diagnosis
- Single most likely diagnosis
- Restless Legs Syndrome (RLS): Given the patient's family history of RLS, the description of muscle aches being worse at night, and the feeling of heavy, swollen legs, RLS is a strong consideration. The patient's symptoms of leg discomfort, heaviness, and numbness in the heels, especially worsening at night, align with RLS characteristics.
- Other Likely diagnoses
- Peripheral Artery Disease (PAD): The patient's history of walking 2-3 miles per day and the symptoms of leg heaviness and swelling could suggest PAD, especially if the patient has risk factors such as smoking, diabetes, or hypertension, which are not mentioned but should be considered.
- Venous Insufficiency: This condition could explain the swelling and heaviness in the legs, especially if the symptoms worsen throughout the day or with prolonged standing.
- Overuse Injury or Shin Splints: Given the patient's regular walking routine, overuse injuries such as shin splints could be a cause of the leg aches, especially if the patient recently increased their walking distance or frequency.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Deep Vein Thrombosis (DVT): Although less likely given the bilateral nature of the symptoms and the absence of recent immobilization or other risk factors, DVT must be considered due to its potential severity and the fact that it can sometimes present with nonspecific symptoms such as leg heaviness and swelling.
- Peripheral Neuropathy: This could be a consideration, especially with the numbness in the heels, and could be due to various causes including diabetes, vitamin deficiencies, or other systemic diseases.
- Rare diagnoses
- Complex Regional Pain Syndrome (CRPS): This is a rare condition that could follow trauma (such as the patient's history of fractures) and is characterized by chronic pain, swelling, and changes in skin temperature and color.
- Erythromelalgia: A rare disorder characterized by burning pain, heat, and redness in the hands and feet, which could potentially explain some of the patient's symptoms, although it is less common and typically involves the hands as well.