Differential Diagnosis for a 67-year-old Female Feeling Hot on Her Soles and Can't Sleep for a Month

• Single most likely diagnosis:
  • Menopause or Perimenopause: This condition is characterized by hot flashes, which can sometimes be localized and accompanied by sleep disturbances due to hormonal changes. The age of the patient aligns with the typical age range for menopause.
• Other Likely diagnoses:
  • Diabetic Neuropathy: This condition can cause burning sensations in the feet and sleep disturbances due to discomfort or pain. Given the age and the specific symptom of feeling hot on the soles, it's a plausible diagnosis.
  • Restless Legs Syndrome (RLS): Characterized by an irresistible urge to move the legs, often accompanied by uncomfortable sensations such as burning, which could be mistaken for feeling hot. Sleep disturbance is a common symptom.
  • Hypothyroidism: Although less common, hypothyroidism can cause sleep disturbances and unusual sensations in the extremities, including feelings of heat.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Deep Vein Thrombosis (DVT): While less likely, DVT can cause a feeling of heat or swelling in one leg and can lead to pulmonary embolism if not treated promptly.
  • Neurological Disorders (e.g., Multiple Sclerosis): Certain neurological conditions can cause a wide range of sensory disturbances, including feelings of heat, and are critical to diagnose early for effective management.
• Rare diagnoses:
  • Erythromelalgia: A rare disorder characterized by burning pain, heat, and redness in the hands and feet. It's less common but could explain the specific symptom of feeling hot on the soles.
  • Complex Regional Pain Syndrome (CRPS): A chronic pain condition that can cause sensations of burning or heat, usually after an injury. It's rare and the presentation might not exactly match the described symptoms, but it's worth considering in a differential diagnosis for unexplained pain or sensory disturbances.