Differential Diagnosis for Swollen Feet and Sensitive Soles
Given the patient's history and laboratory results, the following differential diagnoses are considered:
Single Most Likely Diagnosis
- Diabetic Neuropathy: The patient has a history of diabetes, which is a significant risk factor for developing diabetic neuropathy. This condition can cause sensitive soles and swollen feet due to nerve damage. The patient's long-standing diabetes increases the likelihood of this diagnosis.
Other Likely Diagnoses
- Congestive Heart Failure (CHF): The patient has a history of open-heart surgery and multiple angiograms, which may indicate underlying cardiovascular disease. CHF can cause fluid buildup in the body, leading to swollen feet.
- Renal Insufficiency: The elevated anion gap (27) may suggest underlying renal issues, which can cause fluid retention and swelling in the feet.
- Hypothyroidism: Although not directly mentioned, hypothyroidism can cause swelling in the feet and is more common in patients with diabetes.
Do Not Miss Diagnoses
- Deep Vein Thrombosis (DVT): Although less likely, DVT is a potentially life-threatening condition that can cause swollen and sensitive feet. Given the patient's history of surgery and immobility while waiting for joint replacement, this diagnosis should not be missed.
- Cellulitis or Infection: Bacterial infections like cellulitis can cause redness, swelling, and sensitivity in the feet. In diabetic patients, infections can quickly become severe and require prompt treatment.
- Compartment Syndrome: This is a rare but serious condition that can cause swelling and sensitivity in the feet due to increased pressure within the muscle compartments.
Rare Diagnoses
- Amyloidosis: A group of diseases characterized by the deposition of abnormal proteins (amyloid) in various tissues, which can cause neuropathy and swelling.
- Sarcoidosis: A condition that can cause inflammation and swelling in various parts of the body, including the feet.
- Lymphedema: A chronic condition characterized by the abnormal collection of fluid in the body's tissues, leading to swelling, which is less likely but should be considered if other diagnoses are ruled out.