Differential Diagnosis for Bilateral Foot Swelling and Numbness

Single Most Likely Diagnosis

• Chronic Venous Insufficiency: Given the patient's history of hypertension (HTN) and chronic obstructive pulmonary disease (COPD), chronic venous insufficiency is a plausible cause for bilateral foot swelling. The numbness could be related to secondary nerve compression or damage due to chronic swelling.

Other Likely Diagnoses

• Peripheral Artery Disease (PAD): Although the patient does not have diabetes mellitus (DM), PAD can still occur, especially in the context of long-standing hypertension and smoking history (often associated with COPD). PAD could explain both the swelling and numbness due to reduced blood flow.
• Heart Failure: With a history of HTN, heart failure is a possible diagnosis. It could lead to fluid overload, causing bilateral foot swelling. Numbness might be less directly related but could occur due to decreased mobility and subsequent nerve compression.
• Chronic Kidney Disease: Uncontrolled hypertension can lead to chronic kidney disease, which in turn can cause fluid retention and swelling. Numbness could be a result of electrolyte imbalances or uremic neuropathy.

Do Not Miss Diagnoses

• Deep Vein Thrombosis (DVT): Although less likely given the bilateral presentation, DVT must be considered due to its potential for severe consequences, including pulmonary embolism. Swelling and numbness could be symptoms of DVT.
• Neuropathy due to Vitamin Deficiency: Especially in the context of COPD, where nutritional deficiencies can occur, vitamin B12 deficiency could lead to neuropathic symptoms like numbness.
• Lymphedema: While less common, lymphedema could cause swelling. It's essential to consider, especially if there's a history of cancer or its treatment, though not mentioned here.

Rare Diagnoses

• Amyloidosis: A rare condition that can cause neuropathy and potentially swelling due to fluid accumulation or cardiac involvement leading to heart failure.
• Sarcoidosis: Can cause neuropathy and potentially swelling due to granulomatous infiltration of nerves and other tissues.
• Fabry Disease: A genetic disorder leading to neuropathic pain and potentially swelling due to vascular and renal involvement.

Each of these diagnoses requires careful consideration of the patient's full medical history, physical examination, and potentially further diagnostic testing to determine the underlying cause of the bilateral foot swelling and numbness.