Differential Diagnosis for Burning Pain Plantar with Numbness

Single Most Likely Diagnosis

• Diabetic Neuropathy: This is the most likely diagnosis given the symptoms of burning pain and numbness in the plantar aspect of the foot. Diabetic neuropathy is a common complication of diabetes, affecting the peripheral nerves and causing pain, numbness, and tingling in the feet.

Other Likely Diagnoses

• Tarsal Tunnel Syndrome: This condition involves compression of the posterior tibial nerve as it travels through the tarsal tunnel, leading to pain, numbness, and tingling in the foot. Symptoms can be similar to diabetic neuropathy, making it a likely differential diagnosis.
• Baxter Neuropathy: Also known as inferior calcaneal nerve entrapment, Baxter neuropathy involves compression of the inferior calcaneal nerve, causing pain and numbness on the bottom of the heel. While less common than diabetic neuropathy, it is still a plausible diagnosis given the symptoms.

Do Not Miss Diagnoses

• Deep Vein Thrombosis (DVT): Although less likely, DVT can cause pain and swelling in the leg, which might be confused with neuropathic pain. Missing a DVT could be catastrophic due to the risk of pulmonary embolism.
• Infection or Abscess: Infections in the foot, such as those caused by diabetes or other conditions, can present with pain and numbness. Failing to diagnose and treat an infection promptly could lead to serious complications, including sepsis.
• Charcot Neuroarthropathy: This condition, often associated with diabetic neuropathy, involves the destruction of joints in the foot due to loss of sensation and repetitive trauma. It is crucial to identify and manage Charcot neuroarthropathy to prevent further complications.

Rare Diagnoses

• Leprosy (Hansen's Disease): A chronic bacterial infection that can cause nerve damage leading to numbness and pain in the extremities, including the feet. Although rare in many parts of the world, it should be considered in patients with a history of exposure or travel to endemic areas.
• Amyloidosis: A condition characterized by the deposition of amyloid proteins in various tissues, including nerves, which can lead to neuropathy. The presentation can be similar to diabetic neuropathy, but the diagnosis is much less common.
• Vitamin Deficiency Neuropathy: Deficiencies in vitamins such as B12 can cause neuropathic symptoms similar to diabetic neuropathy. While less common, identifying and treating a vitamin deficiency can reverse the neuropathy, making it an important differential diagnosis.