Differential Diagnosis for Acute Pain in Joint between Big Toe and Feet in Diabetic Patient with Peripheral Artery Disease

• Single Most Likely Diagnosis
  • Gout: This condition is common in diabetic patients and can cause acute, severe pain in the joint between the big toe and the foot, known as the first metatarsophalangeal joint. The pain can be exacerbated by peripheral artery disease, which may reduce blood flow to the area, potentially worsening the symptoms of gout.
• Other Likely Diagnoses
  • Osteoarthritis: While more chronic in nature, osteoarthritis can cause acute exacerbations of pain, especially in a joint that bears significant weight and stress like the first metatarsophalangeal joint. Diabetes and peripheral artery disease can complicate the condition by affecting healing and blood supply.
  • Diabetic Neuropathy: Though typically causing chronic pain, diabetic neuropathy can lead to acute painful episodes, especially if there's an acute injury or if the neuropathy affects the nerves supplying the joint between the big toe and the foot.
  • Septic Arthritis: In diabetic patients, especially those with peripheral artery disease, the risk of infections is higher due to compromised immune response and reduced blood flow. Septic arthritis is a medical emergency that requires prompt diagnosis and treatment.
• Do Not Miss Diagnoses
  • Cellulitis or Soft Tissue Infection: Given the patient's diabetes and peripheral artery disease, any infection in the foot can quickly become severe. Cellulitis or other soft tissue infections can cause acute pain and require immediate antibiotic treatment.
  • Deep Vein Thrombosis (DVT): Though less common in the context of foot pain, DVT can occur in the context of peripheral artery disease and can be a cause of acute pain. It's a critical diagnosis not to miss due to the risk of pulmonary embolism.
  • Osteomyelitis: An infection of the bone, osteomyelitis can cause acute pain and is a significant concern in diabetic patients, especially those with foot ulcers or compromised peripheral circulation.
• Rare Diagnoses
  • Charcot Arthropathy: A condition that occurs in patients with significant neuropathy, leading to destruction of the joint. It's less likely to present as acute pain but can cause significant deformity and disability if not recognized.
  • Rheumatoid Arthritis: Though less common than osteoarthritis, rheumatoid arthritis can cause acute pain in the joints of the foot, including the first metatarsophalangeal joint. It would be unusual for it to present for the first time in this manner in a diabetic patient with peripheral artery disease, but it remains a possibility.