Differential Diagnosis for Left Achilles Pain and Inability to Bear Weight
Single Most Likely Diagnosis
- Tendinitis or Tendinosis: The patient's complaint of Achilles pain, especially in the context of recent or increased physical activity, makes tendinitis or tendinosis a highly plausible diagnosis. Chlorthalidone, a thiazide-like diuretic, can contribute to muscle cramps and possibly exacerbate tendon issues, but the primary cause is more likely related to overuse or strain.
Other Likely Diagnoses
- Achilles Tendon Rupture: Given the inability to bear weight, a rupture should be considered, especially if there was a sudden onset of pain. This condition requires prompt medical attention.
- Insertional Achilles Tendinitis: This condition involves inflammation at the insertion of the Achilles tendon on the calcaneus and can cause significant pain and difficulty walking.
- Bursitis: Inflammation of the retrocalcaneal bursa, which is located between the Achilles tendon and the heel bone, can cause pain and swelling in the area, mimicking Achilles tendon issues.
Do Not Miss Diagnoses
- Deep Vein Thrombosis (DVT): Although less common, DVT can present with calf pain and swelling. Given the patient's history of hypertension and potential for decreased mobility, it's crucial not to miss this diagnosis due to its high risk of pulmonary embolism.
- Compartment Syndrome: A condition characterized by increased pressure within a muscle compartment, leading to pain, swelling, and potentially severe complications if not addressed promptly.
- Infection (e.g., Cellulitis or Abscess): Infections in the soft tissues can cause pain, swelling, and difficulty walking. While less likely without a clear source of infection, it's a critical diagnosis not to miss due to the potential for severe consequences.
Rare Diagnoses
- Seronegative Spondyloarthropathies (e.g., Ankylosing Spondylitis, Psoriatic Arthritis): These conditions can cause enthesitis, which is inflammation at the sites where tendons or ligaments insert into the bone, including the Achilles tendon.
- Gout or Pseudogout: Although more commonly associated with joint pain, these conditions can occasionally cause inflammation around the Achilles tendon.
- Tumor or Cyst: Rarely, a soft tissue tumor or cyst (e.g., ganglion cyst) can cause pain and swelling in the Achilles tendon area.