Differential Diagnosis for Pain over the Head of the First Metatarsal with Walking/Pressure
- Single most likely diagnosis:
- Bunion (Hallux Valgus): This condition is characterized by a bony bump at the base of the big toe, which can cause pain, especially with pressure or walking. The pain is typically localized over the head of the first metatarsal, making it the most likely diagnosis.
- Other Likely diagnoses:
- Sesamoiditis: Inflammation of the sesamoid bones, which are located under the first metatarsal head, can cause pain in this area, especially with activities that put pressure on the ball of the foot.
- Metatarsalgia: This condition refers to pain in the ball of the foot, which can be caused by various factors, including poor foot mechanics, overuse, or ill-fitting shoes. The pain can be localized over the head of the first metatarsal.
- Gout: Although less common, gout can cause pain in the first metatarsophalangeal joint, which may radiate to the head of the first metatarsal.
- Do Not Miss diagnoses:
- Osteonecrosis (Avascular Necrosis) of the First Metatarsal Head: This is a rare but serious condition that can cause pain over the head of the first metatarsal. It is essential to consider this diagnosis to avoid delayed treatment, which can lead to further complications.
- Infection (Osteomyelitis or Septic Arthritis): Infections in the foot can cause severe pain, redness, and swelling. Although less common, it is crucial to rule out infection to prevent serious consequences.
- Rare diagnoses:
- Freiberg's Disease: A rare condition that affects the metatarsal heads, causing pain and stiffness, especially in adolescents.
- Kohler's Disease: A rare bone disorder that affects the tarsal navicular bone but can cause referred pain to the first metatarsal head.
- Neuroma: A benign growth of nerve tissue that can cause pain, usually between the toes, but can occasionally cause pain over the head of the first metatarsal.