Differential Diagnosis for Redness and Pain in the First Toe Joint Spreading to Second and Third Toes

• Single Most Likely Diagnosis

  • Gout: This condition is characterized by sudden, severe attacks of pain, swelling, redness, and tenderness in one or more joints, most often in the big toe. The symptoms described, such as redness of the first toe joint spreading to adjacent toes with pain and mild swelling, are classic for gout, especially if the patient has a history of similar episodes or risk factors like diet, alcohol use, or family history.

• Other Likely Diagnoses

  • Pseudogout (Calcium Pyrophosphate Deposition Disease, CPPD): Similar to gout, pseudogout causes sudden, severe joint pain and swelling, but it is caused by calcium pyrophosphate dihydrate crystal deposition. It can affect various joints, including those in the toes.
  • Septic Arthritis: An infection within a joint, which can cause pain, swelling, redness, and warmth. While less common in the toes compared to larger joints, it's a possible diagnosis, especially if there's a history of trauma, recent surgery, or immunocompromised state.
  • Osteoarthritis: Although typically more chronic and less likely to cause acute redness and swelling, osteoarthritis can lead to pain and stiffness in the toe joints, especially with activity.

• Do Not Miss Diagnoses

  • Cellulitis or Soft Tissue Infection: A bacterial infection of the skin and soft tissues that can spread rapidly and lead to serious complications if not treated promptly. The presence of redness, swelling, and pain could indicate a spreading infection.
  • Deep Vein Thrombosis (DVT): Although less common in the context described, DVT can cause swelling, pain, and redness in the affected limb. It's crucial to consider this diagnosis due to its potential for severe complications like pulmonary embolism.
  • Necrotizing Fasciitis: A rare but life-threatening infection that affects the tissue beneath the skin and surrounding muscles and organs. Early recognition and treatment are critical.

• Rare Diagnoses

  • Rheumatoid Arthritis (RA): While RA can cause pain and swelling in multiple joints, it typically involves the hands and feet symmetrically and is less likely to present with acute redness and swelling localized to a few toe joints.
  • Psoriatic Arthritis: This condition can cause joint pain, swelling, and redness, often accompanied by psoriasis. It might affect the toes but usually presents with other systemic or skin manifestations.
  • Sarcoidosis: A condition that can cause inflammation in various parts of the body, including the joints. Joint involvement in sarcoidosis is less common and would typically be part of a broader systemic presentation.