In a patient with a history of burning pain localized to the plantar aspect of the foot, the differential diagnosis must include:
Ans. is 'c' Tarsal Tunnel SyndromeRef Apley's, 8 th/e page 252, Nelson 16th/e page 2061, Anderson's patho page - 2489H/O of burning pain in the plantar aspect of the foot suggest the diagnosis of tarsal tunnel syndrome.Tarsal Tunnel syndromeIt is caused by the compression of posterior tibial nerve behind and below medial malleolus.Aggravating factors areProlonged weight bearingSpace occupying lesions such as ganglioma, hemangioma or varicosity.Symptoms arePain and sensory disturbances over the plantar surface of the foot.Pain is often worse at night and patient may seek relief by walking around or stamping his or her footSome students had confusion regarding the character of pain in Tarsal tunnel syndrome. Make it clear that neurological pain are usually burning in character (Harrison)About other optionsTarsal coalitionIt represents a congenital fusion or failure of segmentation between two or more tarsal bones.Most commonly it occurs betweenMedial talocalcaneal bonesCalcaneonavicular bonesIt is also known as peroneal spastic flatfoot.It can be easily ruled out as the pain is typically localized in the dorsal foot along the lateral malleolus and is precipitated by walking. More over the main symptom is limitation of joint movement.Plantar fibromatosis -It can be easily ruled out as the main symptom in presence of nodules in the plantar aspect of foot.Presence of pain is unusual.Peripheral vascular diseaseIn peripheral vascular disease the usual site of pain is not the plantar aspect of foot.Pain many occur in toe (or feet too) but the usual sites are distal to location of the occlusive lesions which are usually thigh and calf region.The character of the pain will be ischemic (not neuropathic or burning)
Peripheral vascular disease.
Tarsal coalation.
Tarsal tunnel syndrome
Planter fibromatosis
Peripheral Nerve Injuries