Differential Diagnosis for Severe Foot Pain
Single Most Likely Diagnosis
- Plantar Fasciitis: This condition is characterized by pain in the arch and heel of the foot, often described as a pulling sensation, and can also cause pain on the bone from the pinky toe back. The pain typically worsens after periods of rest, such as in the morning or after sitting for long periods, which aligns with the patient's symptoms. Swelling in the top of the foot and ankle, and pain in calves and knees, can also be associated with plantar fasciitis due to altered gait mechanics.
Other Likely Diagnoses
- Tarsal Tunnel Syndrome: This condition involves compression of the posterior tibial nerve as it travels through the tarsal tunnel on the inner side of the ankle, leading to pain, numbness, and tingling sensations in the foot, including the arch and heel. The "pins and needles" sensation described by the patient is consistent with this diagnosis.
- Peripheral Neuropathy: Given the description of the pain as almost itchy at times and the presence of a "pins and needles" sensation, peripheral neuropathy could be a contributing factor. This condition can cause a variety of sensations, including pain, numbness, and tingling, typically in a stocking and glove distribution.
- Achilles Tendinitis: Pain in the heel and back of the ankle could also suggest Achilles tendinitis, especially if the pain is localized to the area where the Achilles tendon attaches to the calcaneus.
Do Not Miss Diagnoses
- Deep Vein Thrombosis (DVT): Although less likely given the description of the pain, DVT must be considered, especially if there is significant swelling in the foot and ankle. DVT can cause pain and swelling but typically does not cause the specific sensations of "pins and needles" or itchy pain.
- Osteomyelitis or Septic Arthritis: Infection in the bone or joint can cause severe pain, swelling, and difficulty walking. While these conditions might not fully explain the neurological symptoms, they are critical to rule out due to their potential for serious complications.
- Diabetic Neuropathy: If the patient has diabetes, diabetic neuropathy could explain some of the symptoms, including pain, numbness, and tingling in the feet.
Rare Diagnoses
- Complex Regional Pain Syndrome (CRPS): This condition can cause severe, burning pain and swelling, typically in one limb, following an injury or trauma. The description of the pain as severe and the presence of swelling could suggest CRPS, although it is less common.
- Erythromelalgia: A rare disorder characterized by burning pain, heat, and redness in the hands and feet, which could potentially explain some of the patient's symptoms, especially the itchy, burning sensation.