Differential Diagnosis for 74yo M with LT foot pain and swelling at the 5th digit
- Single most likely diagnosis
- Gout: The patient's history of gout and the location of the pain (5th digit) are consistent with a gouty attack, which often affects the base of the big toe but can also occur in other toes. The lack of relief with arthritis cream does not rule out gout, as topical treatments may not be effective for acute gouty arthritis.
- Other Likely diagnoses
- Osteoarthritis: Given the patient's age and the chronic nature of the pain, osteoarthritis of the 5th toe or surrounding joints is a possible cause. However, the acute onset of swelling is less typical for osteoarthritis.
- Bursitis or tendinitis: Inflammation of the bursae or tendons around the 5th toe could cause pain and swelling, especially if the patient has been active or has experienced minor, unreported trauma.
- Hammer toe or claw toe deformity: These deformities can cause pain and swelling, particularly if they lead to pressure sores or ulcers.
- Do Not Miss diagnoses
- Cellulitis or soft tissue infection: Although the patient denies a history of injury, an infection could still be present, especially in diabetic or immunocompromised patients. It's crucial to consider this diagnosis due to the potential for serious complications if left untreated.
- Deep vein thrombosis (DVT): While less common in the foot, DVT could cause swelling and pain, especially if the patient has risk factors such as recent immobility, cancer, or coagulopathy.
- Charcot foot (neuropathic arthropathy): In patients with diabetes or other neuropathic conditions, Charcot foot can cause significant destruction of the foot's bony architecture, leading to pain and swelling.
- Rare diagnoses
- Rheumatoid arthritis: Although less likely given the patient's age and the localized nature of the symptoms, rheumatoid arthritis could still be a consideration, especially if the patient has a history of autoimmune disorders.
- Psoriatic arthritis: This condition can cause joint pain and swelling, often accompanied by skin changes, but it would be unusual for it to present solely in the 5th toe without other symptoms.
- Bone tumor or cyst: A benign or malignant bone tumor could cause localized pain and swelling, but this would be a rare cause of the patient's symptoms.