Differential Diagnosis for Big Toe Pain (not Gout)
Single Most Likely Diagnosis
- Osteoarthritis: This is a common condition that can cause pain in the big toe, especially if there's a history of trauma, repetitive strain, or degenerative changes. The pain is typically worse with movement and improves with rest.
Other Likely Diagnoses
- Sesamoiditis: Inflammation of the sesamoid bones under the first metatarsal bone can cause pain in the big toe, often related to overuse or poor footwear.
- Bursitis: Inflammation of the bursae around the joints of the big toe can cause pain, swelling, and redness, often due to repetitive motion or pressure.
- Ingrown Toenail: A common condition where the nail grows into the surrounding skin, causing pain, redness, and swelling.
- Morton's Neuroma: A condition where a nerve between the toes becomes compressed, causing pain, numbness, and tingling in the big toe.
Do Not Miss Diagnoses
- Infection (Cellulitis or Abscess): Bacterial infections can cause severe pain, redness, swelling, and warmth in the big toe, requiring prompt antibiotic treatment.
- Deep Vein Thrombosis (DVT): Although less common, DVT can cause pain and swelling in the leg, including the big toe, and requires urgent medical attention to prevent pulmonary embolism.
- Diabetic Neuropathy: Nerve damage due to diabetes can cause numbness, tingling, and pain in the feet, including the big toe.
Rare Diagnoses
- Rheumatoid Arthritis: An autoimmune disorder that can cause pain, swelling, and stiffness in the joints, including the big toe.
- Psoriatic Arthritis: A condition that combines psoriasis with joint inflammation, potentially affecting the big toe.
- Tuberculosis of the Bone (Ostearticular TB): A rare infection that can cause pain, swelling, and destruction of the bone and joint in the big toe.
- Erythromelalgia: A rare disorder that causes burning pain, heat, and redness in the hands and feet, including the big toe.