Differential Diagnosis for 87-year-old with Left Foot Pain
Single most likely diagnosis
- Gout: Given the patient's severe pain, inability to walk, and history of similar episodes, gout is a strong consideration. The patient's reduced GFR (30) also increases the risk of gout due to decreased uric acid excretion.
Other Likely diagnoses
- Osteoarthritis: The patient's age and severe foot pain could be indicative of osteoarthritis, especially if she has a history of similar pain episodes.
- Peripheral Artery Disease (PAD): Although less likely given the acute onset, PAD could cause severe leg pain, especially in an elderly patient with potential vascular risk factors.
- Musculoskeletal strain or sprain: Given the patient's age and potential for decreased mobility, a musculoskeletal injury could be a possible cause of her pain.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Deep Vein Thrombosis (DVT): Although the patient does not have fevers, DVT is a critical diagnosis to consider due to its potential for severe consequences, such as pulmonary embolism.
- Cellulitis or abscess: Infection is a concern, especially in an elderly patient with decreased mobility and potential compromised skin integrity.
- Fracture: A stress or insufficiency fracture could cause severe pain and is a critical diagnosis to consider, especially if the patient has osteoporosis or has experienced a recent fall.
Rare diagnoses
- Pseudogout (Calcium Pyrophosphate Deposition Disease): Although less common than gout, pseudogout could cause similar symptoms, especially in an elderly patient with joint disease.
- Erythromelalgia: A rare condition characterized by burning pain, heat, and redness in the feet, which could be considered if other diagnoses are ruled out.
- Complex Regional Pain Syndrome (CRPS): A rare condition characterized by severe, burning pain, usually after an injury or trauma, which could be a possible diagnosis if other causes are excluded.