Differential Diagnosis for Foot Pain
The patient's symptoms of sharp, stabbing pain on the bottom of her foot, worsened by walking and relieved by rest, along with the presence of a tender mass on the sole of her foot, suggest several possible diagnoses. These can be categorized as follows:
Single Most Likely Diagnosis
- Plantar fasciitis or a plantar fascial fibroma: The patient's occupation as a hairdresser, which involves standing for long periods, especially in heels, increases the risk for plantar fasciitis. The description of the pain and the presence of a tender mass are consistent with this diagnosis, as the plantar fascia can become inflamed and form a fibroma.
Other Likely Diagnoses
- Morton's neuroma: This condition involves a thickening of the tissue around the nerves leading to the toes, which can cause sharp, stabbing pain, especially between the toes. However, the presence of a tender mass on the sole of the foot makes this less likely compared to plantar fasciitis.
- Fat pad atrophy: This condition involves the loss of the fatty tissue on the bottom of the foot, which can cause pain, especially when walking. While possible, the specific mention of a tender mass makes this diagnosis less likely.
- Plantar wart: A plantar wart can cause pain on the bottom of the foot, especially if it is located in a weight-bearing area. However, the description of a sharp, stabbing pain and a tender mass is not as typical for a plantar wart.
Do Not Miss Diagnoses
- Osteomyelitis or bone infection: Although less common, an infection of the bone in the foot could present with pain and a mass. This diagnosis is critical to consider because it requires prompt antibiotic treatment or even surgical intervention.
- Tumor (benign or malignant): While rare, a tumor on the bottom of the foot could cause the described symptoms. It is essential to consider this possibility to ensure early detection and treatment if present.
Rare Diagnoses
- Plantar fibromatosis: This is a rare condition characterized by the growth of fibrous tissue on the bottom of the foot, which can cause pain and the formation of nodules or masses.
- Foreign body reaction: If the patient has stepped on something that has penetrated the skin and remains embedded, it could cause a reaction leading to pain and a mass. However, the patient's history does not specifically suggest a recent injury.
- Gout or pseudogout: These conditions involve the deposition of crystals within the joints and can cause acute, severe pain. While they can affect the foot, the presence of a tender mass on the sole is not typical for these conditions.