Differential Diagnosis for Numbness and Burning Sensation in the Right Foot
Single most likely diagnosis:
- Morton's neuroma: This condition is characterized by numbness, burning, or tingling sensations in the toes, often exacerbated by certain footwear or activities like walking. The symptoms described, particularly the involvement of digits 3,4, and 5, and the alleviation with rest, are classic for Morton's neuroma, which typically affects the areas between the toes.
Other Likely diagnoses:
- Metatarsalgia: This condition involves pain and inflammation in the metatarsal area of the foot, which could explain the tenderness and burning sensation along the volar MTP joints. Certain footwear can exacerbate this condition.
- Overuse or repetitive strain injury: Activities that involve repetitive stress on the foot, such as walking, especially in footwear that does not fit properly, can lead to strain and injury of the foot's structures, resulting in numbness and pain.
- Bunion or bunionette: Although these conditions primarily affect the first and fifth toes, respectively, they can cause discomfort and numbness in adjacent toes due to pressure and altered gait mechanics.
Do Not Miss diagnoses:
- Peripheral artery disease (PAD): While less likely given the specific distribution of symptoms and alleviation with rest, PAD can cause intermittent claudication, which is pain in the legs or feet during exercise that stops when resting. It's crucial to consider vascular causes, especially in patients with risk factors for atherosclerosis.
- Deep vein thrombosis (DVT): DVT can cause pain, swelling, and sometimes numbness in the affected limb. Although the symptoms described don't fully align with a typical DVT presentation, any condition that could potentially lead to pulmonary embolism must be considered.
- Tarsal tunnel syndrome: This condition involves compression of the posterior tibial nerve as it travels through the tarsal tunnel on the inner side of the ankle, which can cause numbness, tingling, and pain in the foot.
Rare diagnoses:
- Neuropathies (e.g., diabetic neuropathy, if the patient has diabetes): These conditions can cause numbness, tingling, and burning sensations in the feet but typically have a more widespread distribution and are associated with systemic diseases.
- Complex regional pain syndrome (CRPS): A chronic pain condition that can cause severe burning pain, but it usually follows an injury and is accompanied by other symptoms like swelling, skin changes, and limited range of motion.
- Nerve entrapment syndromes other than Morton's neuroma or tarsal tunnel syndrome, such as entrapment of the superficial peroneal or deep peroneal nerves.