Differential Diagnosis for Patient with Tenderness over Fifth and Fourth Metatarsal and Severe Pain with No Fracture on X-ray
- Single Most Likely Diagnosis
- Peroneal Tendinopathy or Tear: This condition is a common cause of pain and tenderness over the fifth metatarsal, where the peroneal tendons are located. The peroneal tendons can become inflamed or torn, leading to severe pain, especially with activities that involve ankle movement.
- Other Likely Diagnoses
- Ligament Sprain: A sprain of the ligaments surrounding the fourth and fifth metatarsals can cause significant pain and tenderness without a visible fracture on X-ray. This is often due to inversion injuries of the ankle.
- Metatarsal Stress Reaction or Stress Fracture Not Visible on X-ray: Early stress fractures or stress reactions might not be visible on initial X-rays but can cause severe pain and tenderness over the affected metatarsal.
- Bursitis: Inflammation of the bursae around the metatarsals can cause pain and tenderness, especially if the bursae become inflamed due to repetitive motion or direct pressure.
- Do Not Miss Diagnoses
- Osteomyelitis or Bone Infection: Although less common, an infection of the bone can cause severe pain and tenderness without an initial visible fracture on X-ray. This condition requires prompt diagnosis and treatment to prevent serious complications.
- Tumor: A bone tumor, whether benign or malignant, can cause pain and tenderness over the affected area. Although rare, missing a diagnosis of a tumor could have significant implications for the patient's health.
- Rare Diagnoses
- Erythromelalgia: A rare disorder characterized by burning pain, heat, and redness in the hands and feet. It could potentially cause severe pain in the metatarsal area, although it is much less common.
- Complex Regional Pain Syndrome (CRPS): A condition characterized by intense burning or aching pain in the hands or feet after an injury or trauma. It's rare but could be considered in the differential diagnosis for severe, unexplained pain.