Differential Diagnosis for Walking on Glass

The symptom of "walking on glass" is often used to describe a sensation of pain or discomfort in the feet, as if one is walking on broken glass. This sensation can be intermittent, coming and going, and can be caused by various conditions. Here is a differential diagnosis organized into the requested categories:

• Single Most Likely Diagnosis

  • Peripheral Neuropathy: This condition is characterized by damage to the peripheral nerves, often causing pain, numbness, or tingling in the feet. The "walking on glass" sensation is a common complaint among patients with peripheral neuropathy, which can be due to diabetes, vitamin deficiencies, or other causes.

• Other Likely Diagnoses

  • Plantar Fasciitis: Inflammation of the plantar fascia, a band of tissue supporting the arch of the foot, can cause pain that feels like walking on glass, especially after periods of rest or in the morning.
  • Morton's Neuroma: A condition where a nerve in the foot becomes irritated or compressed, leading to pain, numbness, or tingling, often described as feeling like one is walking on a pebble or glass.
  • Tarsal Tunnel Syndrome: Similar to carpal tunnel syndrome but affecting the nerves in the ankle, this condition can cause pain, numbness, and tingling in the feet, potentially leading to the "walking on glass" sensation.

• Do Not Miss Diagnoses

  • Deep Vein Thrombosis (DVT): While less common as a cause for this specific symptom, DVT can cause leg pain and swelling. Missing this diagnosis could be deadly due to the risk of pulmonary embolism.
  • Osteomyelitis or Septic Arthritis: Infections of the bone or joint can cause severe pain and should be considered, especially if there's a history of trauma, fever, or other signs of infection.

• Rare Diagnoses

  • Erythromelalgia: A rare disorder characterized by burning pain, heat, and redness in the hands and feet, which could potentially be described as a "walking on glass" sensation.
  • Complex Regional Pain Syndrome (CRPS): A condition characterized by intense burning or aching pain in the hands or feet after an injury or trauma, which might be described in this manner.
  • Fabry Disease: A genetic disorder that can cause burning pain in the hands and feet, among other symptoms, due to the accumulation of a particular type of fat in the body's cells.

Each of these diagnoses has a different set of underlying causes and requires a distinct approach to management and treatment. A thorough medical history, physical examination, and sometimes additional diagnostic tests are necessary to determine the correct diagnosis.