Differential Diagnosis for a Sore Big Toe
- Single most likely diagnosis
- Hallux valgus or bunion: This condition is often caused by tight or poorly fitting shoes that put pressure on the big toe, leading to inflammation and pain. The fact that the toe doesn't seem infected and the pain is associated with tight shoes makes this a likely diagnosis.
- Other Likely diagnoses
- Gout: A form of arthritis characterized by sudden, severe attacks of pain, swelling, redness, and tenderness in the joints, often occurring at the base of the big toe. While the question mentions the toe doesn't seem infected, gout can present without obvious signs of infection.
- Ingrown toenail: This condition occurs when the corner of a toenail grows into the surrounding skin, causing pain, redness, and swelling. Tight shoes can exacerbate this condition.
- Morton's neuroma: A condition that involves a thickening of the tissue around one of the nerves leading to the toes, often caused by pressure from tight shoes.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Osteomyelitis: A bone infection that can occur in the toe, which might not always present with obvious signs of infection like redness or pus. It's crucial to consider this diagnosis, especially if the pain is severe or persistent.
- Deep vein thrombosis (DVT): Although less common in the toes, DVT can occur and is a life-threatening condition if not treated promptly. Pain and swelling in the leg or toe could be indicative of a DVT.
- Rare diagnoses
- Rheumatoid arthritis: An autoimmune disorder that can cause pain and swelling in the joints, including those in the toes. While it's less likely to present solely in the big toe, it's a consideration in the differential diagnosis.
- Psoriatic arthritis: A type of arthritis that occurs in some people with psoriasis, which can cause pain, swelling, and stiffness in the joints, including the toes.
- Sesamoiditis: Inflammation of the sesamoid bones, which are located under the first metatarsal bone in the foot. This condition can cause pain in the big toe, especially with pressure from tight shoes.