Differential Diagnosis for Constant Feeling like Big Toe has to Crack and Very Stiff Big Toe

• Single most likely diagnosis
  • Hallux Limitus: This condition is characterized by a reduction in the range of motion of the big toe, often accompanied by stiffness and a feeling that the toe needs to be cracked. It is a common cause of big toe stiffness and the sensation of needing to crack the toe.
• Other Likely diagnoses
  • Gout: Gout can cause stiffness, pain, and swelling in the big toe, potentially leading to a feeling that the toe needs to crack due to the buildup of uric acid crystals.
  • Hallux Rigidus: Similar to hallux limitus, hallux rigidus is a condition where the big toe becomes stiff, but in this case, it is due to arthritis, leading to pain and limited mobility.
  • Sesamoiditis: Inflammation of the sesamoid bones under the big toe can cause pain and stiffness, potentially leading to the sensation that the toe needs to crack.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Osteonecrosis: Although rare, osteonecrosis (death of bone tissue) in the big toe could lead to stiffness and pain. Missing this diagnosis could result in significant morbidity.
  • Infection (e.g., osteomyelitis): An infection of the bone in the big toe could cause stiffness, pain, and a feeling that the toe needs to crack. Missing this diagnosis could lead to serious complications, including the spread of infection.
• Rare diagnoses
  • Tumor (benign or malignant): A tumor in the big toe could cause stiffness and pain, potentially leading to the sensation that the toe needs to crack. Although rare, it is an important consideration to rule out.
  • Neuroma: A neuroma, especially a Morton's neuroma located between the toes, could cause pain and stiffness that might radiate to the big toe, leading to the sensation of needing to crack it.