Differential Diagnosis

The patient presents with two main complaints: globus sensation and bilateral heel pain. Here's a differential diagnosis organized into categories:

• Single most likely diagnosis

  • Globus sensation: Gastroesophageal Reflux Disease (GERD) - The patient's symptoms of feeling like food is stuck in the throat without dysphagia or odynophagia could be related to GERD, especially given the intermittent nature of the symptoms.
  • Bilateral heel pain: Plantar Fasciitis - The tenderness on the plantar aspect of both heels, worsened by activities like work that involve standing, points towards plantar fasciitis, a common condition in individuals who stand for long periods.

• Other Likely diagnoses

  • Globus sensation:
    • Anxiety or Stress - Can cause or exacerbate globus sensation.
    • Hypothyroidism - Although the patient is on levothyroxine, if the hypothyroidism is not well-controlled, it could contribute to the sensation.
  • Bilateral heel pain:
    • Achilles Tendinitis - Could be considered if the pain is more posterior.
    • Fat Pad Atrophy - Less common but possible, especially in older adults.

• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)

  • Globus sensation:
    • Esophageal Cancer - Although rare and less likely, it's crucial to rule out, especially if symptoms persist or worsen.
    • Thyroid Cancer - Given the patient's history of hypothyroidism, any new or worsening throat symptoms should prompt consideration of thyroid cancer.
  • Bilateral heel pain:
    • Infectious or Inflammatory Arthritis - Conditions like septic arthritis or rheumatoid arthritis can cause heel pain and are medical emergencies.
    • Bone Tumors - Rare, but heel pain could be a symptom of a bone tumor.

• Rare diagnoses

  • Globus sensation:
    • Eosinophilic Esophagitis - An allergic inflammatory condition of the esophagus.
    • Cricopharyngeal Spasm - A rare condition that can cause difficulty swallowing and a sensation of something being stuck in the throat.
  • Bilateral heel pain:
    • Seronegative Spondyloarthropathies - Conditions like psoriatic arthritis or ankylosing spondylitis can cause heel pain.
    • Paget's Disease of Bone - A rare condition that can affect the heel bones among others.