Differential Diagnosis for Posterior Great Toe Tenderness

Single Most Likely Diagnosis

• Sesamoiditis: This condition is characterized by inflammation of the sesamoid bones or the tendons surrounding them, located beneath the first metatarsal bone. It's a common cause of pain in the ball of the foot, especially under the big toe, and can be exacerbated by activities that put pressure on the foot.

Other Likely Diagnoses

• Turf Toe: An injury to the ligaments around the big toe joint, often caused by hyperextension. It could present with tenderness, especially if the injury is not acute but rather a result of repetitive strain.
• Gout: A form of inflammatory arthritis characterized by sudden, severe attacks of pain, swelling, redness, and tenderness. It often affects the joint at the base of the big toe.
• Morton's Neuroma: A condition that involves a thickening of the tissue around one of the nerves leading to the toes. It can cause pain, usually between the third and fourth toes, but can sometimes affect the area around the big toe.
• Bursitis: Inflammation of a bursa, which is a fluid-filled sac that cushions bones, tendons, and muscles near joints. Bursitis near the big toe can cause pain and swelling.

Do Not Miss Diagnoses

• Infection (Cellulitis or Abscess): Although less common, an infection in the foot can present with localized pain, redness, and swelling. It's crucial to identify and treat infections promptly to prevent serious complications.
• Deep Vein Thrombosis (DVT): While DVT typically presents with swelling, pain, and discoloration of the entire leg, it's a potentially life-threatening condition that requires immediate medical attention.
• Osteomyelitis: A bone infection that can cause pain, swelling, and redness. It's a serious condition that may not always present with systemic symptoms like fever.

Rare Diagnoses

• Freiberg's Disease: A rare condition that affects the metatarsal bones in the foot, causing pain and tenderness, especially in the ball of the foot.
• Kohler's Disease: A rare bone disorder causing pain and swelling in the foot, typically affecting children.
• Erythromelalgia: A disorder that causes burning pain, heat, and redness in the hands and feet, which could potentially cause localized tenderness.

Each of these diagnoses has a different set of implications for treatment and management, emphasizing the importance of a thorough evaluation to determine the underlying cause of posterior great toe tenderness.