Differential Diagnosis for Big Toe Pain after Trauma
After ruling out fracture and dislocation, the differential diagnosis for big toe pain can be categorized as follows:
- Single Most Likely Diagnosis
- Gout: This is a common condition that can be triggered by trauma, leading to sudden onset of intense pain, redness, and swelling in the big toe. The trauma can crystallize urate in the joint, causing an acute gouty attack.
- Other Likely Diagnoses
- Sprain: A sprain of the ligaments surrounding the big toe can occur due to trauma, leading to pain, swelling, and limited mobility.
- Contusion: A bruise or contusion of the soft tissues around the big toe can cause pain, swelling, and discoloration.
- Sesamoiditis: Inflammation of the sesamoid bones or the tendons surrounding them can cause pain in the big toe, especially if the trauma involved repetitive stress or pressure on the sesamoid bones.
- Do Not Miss Diagnoses
- Osteomyelitis: Although less common, osteomyelitis (bone infection) can occur after trauma, especially if the skin was broken, allowing bacteria to enter the bone. This condition requires prompt treatment to prevent serious complications.
- Compartment Syndrome: This is a condition where increased pressure within a muscle compartment can lead to nerve and muscle damage. It is a medical emergency that requires immediate attention.
- Rare Diagnoses
- Turf Toe: A rare condition that occurs when the ligaments under the big toe are stretched or torn, often due to hyperextension of the toe. It is more common in athletes who participate in sports that involve running or jumping.
- Neuroma: A benign growth of nerve tissue can cause pain, numbness, or tingling in the big toe, especially if the trauma damaged the nerves.
- Infection (e.g., cellulitis, abscess): Although less common, infections can occur after trauma, especially if the skin was broken or if there was a pre-existing condition that compromised the immune system.