Differential Diagnosis for Chronic Right Achilles Tendon Pain
- Single most likely diagnosis
- Achilles Tendinosis: This condition is characterized by chronic pain, swelling, and degeneration of the Achilles tendon, often due to repetitive strain and overuse. The patient's history of walking on her tiptoes, recent increase in running distance, and symptoms of sharp and burning pain, particularly after rest, are consistent with Achilles tendinosis.
- Other Likely diagnoses
- Achilles Tendinitis: Inflammation of the Achilles tendon, which can be caused by overuse, poor foot mechanics, or sudden increases in physical activity. The patient's symptoms of pain exacerbated by physical activity and prolonged standing, as well as intermittent tightness in the Achilles tendon, could also suggest tendinitis.
- Haglund's Deformity: A bony protrusion on the back of the heel that can cause irritation and inflammation of the Achilles tendon, leading to pain and stiffness. The patient's long history of walking on her tiptoes may have contributed to the development of this condition.
- Retrocalcaneal Bursitis: Inflammation of the bursa that separates the Achilles tendon from the heel bone, which can cause pain and swelling in the area. The patient's symptoms of sharp and burning pain, particularly in the morning and after periods of rest, could be consistent with bursitis.
- Do Not Miss diagnoses
- Achilles Tendon Rupture: A complete or partial tear of the Achilles tendon, which can be caused by sudden contractions of the calf muscles or direct blows to the tendon. Although the patient denies any specific injury, a rupture could have occurred without a clear incident, and it is essential to rule out this condition due to its significant implications for treatment and prognosis.
- Infection or Abscess: Although less likely, an infection or abscess in the Achilles tendon or surrounding tissues could cause severe pain, swelling, and redness. It is crucial to consider this possibility, especially if the patient has a history of recent trauma, injection, or other predisposing factors.
- Rare diagnoses
- Seronegative Spondyloarthropathy: A group of inflammatory conditions that can cause enthesitis (inflammation of the tendons and ligaments), including the Achilles tendon. Although rare, this condition could be considered if the patient has other symptoms such as back pain, uveitis, or skin lesions.
- Tumor or Cyst: A rare possibility, but a tumor or cyst in the Achilles tendon or surrounding tissues could cause chronic pain and swelling. Imaging studies would be necessary to rule out this possibility.