Differential Diagnosis for Forefoot Pain in a Child
Single Most Likely Diagnosis
- Sever's Disease: This is the most common cause of heel pain in children, but it can also cause forefoot pain. It is an inflammatory condition of the growth plate in the calcaneus, but similar conditions can affect the growth plates in the forefoot, leading to pain.
Other Likely Diagnoses
- Morton's Neuroma: A common condition characterized by a benign neuroma of an intermetatarsal plantar nerve, typically between the third and fourth toes, causing pain, numbness, and tingling in the forefoot.
- Ingrown Toenail: A condition where the nail grows into the surrounding skin, causing pain, redness, and swelling, often affecting the big toe.
- Overuse Injuries: Such as stress fractures or shin splints, which can occur due to repetitive stress on the bones and muscles of the forefoot, common in active children.
- Flat Feet or Pes Planus: A condition where the arch of the foot collapses, leading to strain on the muscles and bones of the forefoot, causing pain.
Do Not Miss Diagnoses
- Osteomyelitis: A bone infection that can cause severe pain, redness, and swelling, and if left untreated, can lead to serious complications, including bone destruction and sepsis.
- Bone Tumors: Such as osteosarcoma or Ewing's sarcoma, which are rare but can cause forefoot pain and are potentially life-threatening if not diagnosed and treated promptly.
- Neurological Conditions: Such as peripheral neuropathy or nerve entrapment, which can cause forefoot pain, numbness, and tingling, and may be associated with underlying conditions like diabetes or vitamin deficiencies.
Rare Diagnoses
- Freiberg's Disease: A rare condition characterized by avascular necrosis of the metatarsal head, typically affecting the second metatarsal, causing forefoot pain.
- Köhler's Disease: A rare condition characterized by avascular necrosis of the navicular bone, causing midfoot pain, but can also affect the forefoot.
- Charcot-Marie-Tooth Disease: A group of inherited disorders that affect the peripheral nerves, causing muscle weakness, atrophy, and forefoot pain.