Differential Diagnosis for Foot Pain with No Flexion and Constant Swelling after Crush Injury
Single Most Likely Diagnosis
- Chronic Regional Pain Syndrome (CRPS) Complications: Given the history of CRPS following a crush injury 10 years ago, complications or progression of CRPS, including persistent pain, swelling, and limited mobility, are the most likely explanation for the current symptoms.
Other Likely Diagnoses
- Post-Traumatic Arthritis: The crush injury could have led to joint damage, resulting in post-traumatic arthritis, which would cause pain, swelling, and limited mobility in the foot.
- Nerve Damage or Neuropathy: Direct nerve injury from the crush or as a complication of CRPS could lead to chronic pain, numbness, and motor dysfunction, including the inability to flex the foot.
- Chronic Edema: Persistent swelling could be due to chronic edema, possibly secondary to lymphatic or venous damage from the initial injury.
Do Not Miss Diagnoses
- Osteomyelitis or Chronic Infection: Although less likely, chronic infection of the bone or soft tissues could present with persistent pain, swelling, and limited mobility, and is critical to diagnose due to its potential for serious complications.
- Tumor or Cancer: Rarely, chronic pain and swelling could be the first signs of a tumor, either primary or metastatic, in the foot, which would be catastrophic if missed.
- Deep Vein Thrombosis (DVT): While less common in this context, DVT could cause chronic swelling and pain, especially if there's a history of immobility or other risk factors.
Rare Diagnoses
- Complex Vascular Malformations: Rarely, a crush injury could lead to the formation of complex vascular malformations, such as arteriovenous malformations, which could cause chronic pain, swelling, and other symptoms.
- Sickle Cell Disease or Other Hemoglobinopathies: In individuals with sickle cell disease or other hemoglobinopathies, a crush injury could precipitate sickling crises, leading to chronic pain and swelling in the affected limb.
- Erythromelalgia: A rare disorder characterized by burning pain, heat, and redness in the hands and feet, which could be considered in the differential diagnosis of chronic foot pain and swelling, especially if other symptoms are present.