What is the cause of a 13-year-old male's throbbing pain in his right middle toe, which began yesterday and worsens with activity, after stubbing his toe, with a pain scale of 7/10, peaking at 10/10?

Differential Diagnosis for 13-year-old Male with Toe Pain

Single Most Likely Diagnosis

• Traumatic Toe Injury: The patient's history of stubbing his toe and the acute onset of throbbing pain, exacerbated by activity, makes this the most likely diagnosis. The location and nature of the pain are consistent with a traumatic injury, such as a bruise or fracture.

Other Likely Diagnoses

• Toe Fracture: Given the mechanism of injury (stubbing the toe) and the severity of pain (7/10, worsening to 10/10), a fracture of the toe is a plausible diagnosis. The pain's exacerbation with activity further supports this possibility.
• Soft Tissue Injury: An injury to the soft tissues surrounding the toe, such as ligaments or tendons, could also explain the patient's symptoms. This might include a sprain or strain from the traumatic event.
• Ingrown Toenail: Although less directly related to the traumatic event, an ingrown toenail could cause significant pain, especially if infected. However, the acute onset and relation to activity make this less likely than a direct injury.

Do Not Miss Diagnoses

• Osteomyelitis: Although unlikely given the acute onset and traumatic history, osteomyelitis (bone infection) is a serious condition that could present with severe pain. It's crucial to consider this, especially if the patient has a history of recurrent infections or immune compromise.
• Compartment Syndrome: This is a rare but serious condition that could occur after a traumatic injury, leading to increased pressure within the muscle compartments of the foot. It's characterized by severe pain, pallor, poikilothermia, paresthesia, and pulselessness, and requires immediate medical attention.

Rare Diagnoses

• Gout: Although extremely rare in adolescents, gout could theoretically present with acute, severe pain in a single toe. However, this would be unusual without a family history or other predisposing factors.
• Neuroma: A neuroma, such as a Morton's neuroma, could cause pain in the toes but typically presents with a more chronic history and specific locations between the toes.
• Bone Tumor: Bone tumors, such as osteosarcoma or Ewing's sarcoma, are rare and usually present with chronic pain and other systemic symptoms. They are unlikely given the acute onset and traumatic history but should be considered in the differential diagnosis to ensure no serious condition is missed.