Differential Diagnosis for Bilateral Achilles Tendon Pain in a 28-Year-Old Female Runner
- Single Most Likely Diagnosis
- Achilles Tendinopathy: This is the most likely diagnosis due to the patient's age, sex, and running history. Achilles tendinopathy is a common overuse injury in runners, causing pain, stiffness, and swelling in the Achilles tendon.
- Other Likely Diagnoses
- Achilles Tendonitis: Similar to tendinopathy, tendonitis is an inflammation of the Achilles tendon, often caused by overuse or repetitive strain, which is common in runners.
- Retrocalcaneal Bursitis: This condition involves inflammation of the bursa that separates the Achilles tendon from the calcaneus (heel bone), which can cause pain in the Achilles tendon area, especially with running.
- Haglund's Deformity: A bony protrusion on the back of the heel bone can irritate the Achilles tendon, leading to pain and inflammation, particularly in runners who wear shoes that rub against the heel.
- Do Not Miss Diagnoses
- Achilles Tendon Rupture: Although less likely in a bilateral presentation without a history of trauma, a rupture could be partial and bilateral, or the patient might have ruptured one tendon and is experiencing pain in the other due to compensation. This diagnosis is critical to identify promptly due to the significant difference in treatment approach.
- Infection (e.g., Cellulitis or Abscess): Infection in the soft tissues around the Achilles tendon could present with pain, swelling, and redness. Identifying an infection early is crucial for effective treatment and preventing serious complications.
- Seronegative Spondyloarthropathy (e.g., Ankylosing Spondylitis): These conditions can cause enthesitis, which is inflammation where tendons or ligaments insert into the bone, including the Achilles tendon. Early diagnosis can significantly impact the management and prognosis of these diseases.
- Rare Diagnoses
- Rheumatoid Arthritis: Although more commonly associated with small joints of the hands and feet, rheumatoid arthritis can cause inflammation in any tendon, including the Achilles tendon.
- Gout or Pseudogout: These conditions can cause sudden, severe inflammatory arthritis and can occasionally affect the Achilles tendon, leading to pain and swelling.
- Tumor or Cyst: Rarely, a tumor (benign or malignant) or a cyst (e.g., ganglion cyst) can develop near the Achilles tendon, causing pain and swelling.