Big Toe Pain Differential Diagnosis
The following is a differential diagnosis for big toe pain, categorized for clarity and importance.
Single Most Likely Diagnosis
- Gout: This is the most likely diagnosis due to its high prevalence and the fact that the big toe is the most common site for gout attacks. Gout is characterized by sudden, severe pain, redness, and swelling, often occurring at night.
Other Likely Diagnoses
- Osteoarthritis: Wear and tear on the joint can cause pain and stiffness, especially in older adults. The big toe is a common site for osteoarthritis due to its weight-bearing role.
- Bunions: A bony bump at the base of the big toe can cause pain, especially if it rubs against shoes.
- Ingrown Toenail: The big toe is a common site for ingrown toenails, which can cause pain, redness, and swelling.
- Sesamoiditis: Inflammation of the tendons surrounding the sesamoid bones under the big toe can cause pain, especially with weight-bearing activities.
Do Not Miss Diagnoses
- Septic Arthritis: Bacterial infection of the joint can cause severe pain, redness, and swelling, and requires prompt antibiotic treatment to prevent joint destruction.
- Osteomyelitis: Bone infection can cause pain, redness, and swelling, and requires prompt antibiotic treatment to prevent serious complications.
- Deep Vein Thrombosis (DVT): Although less common in the foot, DVT can cause pain and swelling, and requires prompt anticoagulation to prevent pulmonary embolism.
- Diabetic Neuropathy: Nerve damage from diabetes can cause pain, numbness, and tingling in the feet, and requires prompt management to prevent further complications.
Rare Diagnoses
- Rheumatoid Arthritis: Although less common in the big toe, rheumatoid arthritis can cause pain, stiffness, and swelling, especially in multiple joints.
- Psoriatic Arthritis: Inflammation of the joint and skin can cause pain, stiffness, and swelling, especially in patients with psoriasis.
- Tumor or Cyst: Rarely, a tumor or cyst can cause pain and swelling in the big toe, and requires prompt evaluation and treatment.
- Neuroma: A benign growth of nerve tissue can cause pain, numbness, and tingling in the foot, especially between the toes.