Differential Diagnosis for 31 yo Female with Foot Injury
- Single most likely diagnosis:
- Ankle fracture or severe ankle sprain: The mechanism of injury (falling down stairs and landing on foot) and the symptoms (significant bruising, limited ROM, ability to bear weight) are consistent with an ankle fracture or severe sprain. The development of numbness and tingling in toes and heel may indicate nerve involvement or compartment syndrome, which can be a complication of ankle fractures or severe sprains.
- Other Likely diagnoses:
- Compartment syndrome: The symptoms of numbness, tingling, and warmth in the left lateral calf are concerning for compartment syndrome, which is a serious complication that can occur after an ankle injury.
- Peroneal tendon injury: The mechanism of injury and the location of pain and numbness (lateral calf and foot) are consistent with a peroneal tendon injury.
- Ligamentous injury: The limited ROM and bruising are consistent with a ligamentous injury, such as a deltoid ligament or syndesmotic ligament injury.
- Do Not Miss diagnoses:
- Deep vein thrombosis (DVT): Although less likely, DVT is a potentially life-threatening condition that can occur after an injury, especially if there is significant swelling and warmth in the affected leg.
- Osteonecrosis: If the patient has a fracture, there is a risk of osteonecrosis, especially if the fracture involves the talus or calcaneus.
- Infection: The warmth and redness in the left lateral calf could be indicative of an infection, which is a serious complication that requires prompt treatment.
- Rare diagnoses:
- Rupture of the plantaris tendon: Although rare, a rupture of the plantaris tendon can occur after a sudden contraction of the muscle, such as when landing on the foot after a fall.
- Stress fracture: A stress fracture is a rare possibility, especially if the patient has a history of repetitive stress or overuse injuries. However, the acute onset of symptoms after a fall makes this diagnosis less likely.