Differential Diagnosis for 24 yo Male Patient with Bilateral Foot Pain and Numbness

• Single Most Likely Diagnosis
  • Peripheral Artery Disease (PAD): The patient's symptoms of bilateral foot pain, numbness, and tingling, combined with limited range of motion (ROM) in the left foot, weak pedal pulses, and delayed capillary refill, suggest impaired blood flow to the feet. The history of previous foot surgery and potential for similar issues in the right foot further supports this diagnosis, as PAD can be exacerbated by surgical interventions and immobilization.
• Other Likely Diagnoses
  • Neuropathy: Given the patient's complaints of numbness and tingling in both feet, neuropathy is a plausible diagnosis. This could be related to the previous surgery, immobilization, or other underlying conditions such as diabetes, although there's no mention of such conditions in the provided history.
  • Complex Regional Pain Syndrome (CRPS): The patient's history of surgery, limited ROM, and pain in the left foot could suggest CRPS, especially if the pain is out of proportion to the expected healing process.
  • Deep Vein Thrombosis (DVT) or Chronic Venous Insufficiency: Although less likely given the bilateral nature of symptoms and the presence of weak pedal pulses, DVT or chronic venous insufficiency could contribute to the patient's symptoms, particularly if there's a history of prolonged immobilization during incarceration.
• Do Not Miss Diagnoses
  • Acute Limb Ischemia: This is a medical emergency that requires immediate attention. The patient's weak pedal pulses and delayed capillary refill could indicate severe impairment of blood flow, which necessitates urgent evaluation and possible intervention to prevent limb loss.
  • Osteomyelitis or Chronic Infection: Given the patient's history of foot surgery and hardware placement, there's a risk of chronic infection or osteomyelitis, especially if the patient has been incarcerated and had limited access to follow-up care. This condition could lead to severe consequences if not addressed promptly.
• Rare Diagnoses
  • Erythromelalgia: A rare disorder characterized by burning pain, heat, and redness in the hands and feet, which could potentially explain some of the patient's symptoms, although it's less likely given the context.
  • Fabry Disease: A genetic disorder that can lead to peripheral neuropathy, among other symptoms. It's rare and would be an unlikely primary diagnosis without other supporting signs or family history.