Differential Diagnosis for Right Foot Pain

The patient's presentation of right foot pain, particularly with shooting pains at the back of the foot exacerbated by ambulation and not relieved by changing footwear, suggests several potential diagnoses. These can be categorized as follows:

• Single Most Likely Diagnosis

  • Plantar Fasciitis: This condition is characterized by inflammation of the plantar fascia, leading to pain in the heel and bottom of the foot. The pain is typically worse with the first steps in the morning and can be exacerbated by activities such as walking or running. The patient's description of pain worse towards the posterior aspect of the heel and exacerbated by ambulation aligns with plantar fasciitis.

• Other Likely Diagnoses

  • Achilles Tendinitis: Inflammation of the Achilles tendon can cause pain at the back of the heel, which worsens with activity. The patient's report of shooting pains at the back of her foot could be consistent with Achilles tendinitis, especially if the pain is localized to the area just above the heel.
  • Peroneal Tendinitis: This condition involves inflammation of the peroneal tendons, which run along the outside of the ankle. It can cause pain and instability in the ankle, potentially radiating to the foot.
  • Tarsal Tunnel Syndrome: Similar to carpal tunnel syndrome in the wrist, tarsal tunnel syndrome involves compression of the posterior tibial nerve as it travels through the tarsal tunnel on the inner side of the ankle. This can cause pain, numbness, and tingling in the foot.

• Do Not Miss Diagnoses

  • Deep Vein Thrombosis (DVT): Although less common, DVT should be considered, especially if there are risk factors such as recent travel, immobilization, or a family history of clotting disorders. DVT can cause leg pain and swelling but is a medical emergency due to the risk of pulmonary embolism.
  • Osteomyelitis or Septic Arthritis: Infection of the bone or joint can cause severe pain, redness, and swelling. These conditions are medical emergencies requiring prompt antibiotic treatment.
  • Peripheral Artery Disease (PAD): PAD involves narrowing of the arteries to the legs, which can cause pain in the feet or legs during exercise (claudication). While less likely given the patient's age and presentation, it's crucial not to miss this diagnosis due to its implications for cardiovascular health.

• Rare Diagnoses

  • Baxter's Neuroma: A condition involving compression of the inferior calcaneal nerve, leading to pain in the heel.
  • Haglund's Deformity: A bony enlargement at the back of the heel that can cause pain, especially if it irritates the Achilles tendon.
  • Stress Fracture: A small crack in one of the bones in the foot, which can cause pain that worsens with activity. Stress fractures are more common in athletes or individuals with sudden increases in physical activity.