Differential Diagnosis for Big Toe Pain
- Single most likely diagnosis
- Gout: This is often the first consideration for big toe pain, especially if it's sudden, severe, and accompanied by redness and swelling. Gout is a form of inflammatory arthritis characterized by sudden, severe attacks of pain, swelling, redness, and tenderness in one or more joints, most often in the big toe.
- Other Likely diagnoses
- Osteoarthritis: Wear and tear on the joint can cause pain and stiffness in the big toe. This condition is more chronic and progressive compared to gout.
- Ingrown toenail: This condition occurs when the nail grows into the surrounding skin, causing pain, redness, and swelling.
- Sesamoiditis: Inflammation of the tendons surrounding the sesamoid bones (small bones embedded within tendons) under the first metatarsal bone can cause pain in the big toe.
- Bursitis: Inflammation of the fluid-filled sacs (bursae) that cushion bones, tendons, and muscles near the big toe joint can cause pain.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Septic arthritis: A bacterial or fungal infection within the joint space, which is a medical emergency requiring prompt treatment to prevent joint destruction and potential systemic infection.
- Cellulitis or abscess: Bacterial infections of the skin and soft tissues that can spread and become serious if not treated promptly.
- Deep vein thrombosis (DVT): Although less common in the foot, DVT can cause pain and swelling and is a medical emergency due to the risk of pulmonary embolism.
- Rare diagnoses
- Rheumatoid arthritis: An autoimmune disorder that can cause pain and swelling in multiple joints, including the big toe, though it's less common as a presenting symptom.
- Psoriatic arthritis: A type of arthritis that occurs in some people with psoriasis, causing joint pain, swelling, and stiffness, including in the big toe.
- Neuroma: A growth or tumor of nerve tissue that can develop in various parts of the body, including between the toes, causing pain, numbness, or tingling.
- Fracture: A break in one of the bones of the big toe or the surrounding bones, which can be acute or stress-induced and might not always be immediately apparent.