Differential Diagnosis for Achilles Tendon Pain
Single Most Likely Diagnosis
- Achilles Tendinosis or Tendinitis: Given the patient's history of Achilles tendon rupture and current presentation of severe heel pain with walking, Achilles tendinosis or tendinitis is the most likely diagnosis. This condition is characterized by inflammation and degeneration of the tendon, which can cause chronic pain and is common in individuals with a history of tendon rupture.
Other Likely Diagnoses
- Achilles Tendon Re-rupture: Although the patient has a history of Achilles tendon rupture, re-rupture is a possibility, especially if the initial rupture was not properly healed or if the patient has returned to activity too quickly.
- Insertional Achilles Tendinitis: This condition occurs when the tendon becomes inflamed at the point where it inserts into the heel bone, causing pain and stiffness.
- Haglund's Deformity: A bony growth on the back of the heel bone can cause irritation and inflammation of the Achilles tendon, leading to pain and discomfort.
Do Not Miss Diagnoses
- Deep Vein Thrombosis (DVT): Although less likely, DVT can cause calf pain and swelling, which may be mistaken for Achilles tendon pain. It is a potentially life-threatening condition that requires prompt diagnosis and treatment.
- Infection or Abscess: Infection of the tendon or surrounding tissue can cause severe pain, redness, and swelling, and requires urgent medical attention.
- Tumor or Cyst: A tumor or cyst in the Achilles tendon or surrounding tissue can cause pain and swelling, and although rare, should not be missed.
Rare Diagnoses
- Rheumatologic Disorders: Certain rheumatologic disorders, such as rheumatoid arthritis or spondyloarthritis, can cause Achilles tendon pain and inflammation, although this is less common.
- Seronegative Spondyloarthropathy: This group of disorders, including ankylosing spondylitis and psoriatic arthritis, can cause enthesitis, which is inflammation of the tendon where it attaches to the bone.