Differential Diagnosis for Pain in Great Toe Spreading to Second and Third Toes
Single Most Likely Diagnosis
- Morton's Neuroma: This condition is characterized by a benign growth of nerve tissue in the ball of the foot, typically between the third and fourth toes, but can also occur between the second and third toes. It causes pain, numbness, or tingling, especially when walking or wearing tight shoes, which matches the symptoms described.
Other Likely Diagnoses
- Metatarsalgia: This refers to pain in the ball of the foot, which can be caused by various factors including poor foot mechanics, overuse, or ill-fitting shoes. The pain can radiate to adjacent toes.
- Gout: A form of arthritis characterized by sudden, severe attacks of pain, swelling, redness, and tenderness, often occurring at the base of the big toe but can affect other toes as well. It's more common in men and can be triggered by diet, alcohol, or certain medications.
- Bunion: A bony bump that forms on the joint at the base of the big toe, causing pain and discomfort, especially when walking or wearing shoes that put pressure on it. The pain can spread to adjacent toes.
Do Not Miss Diagnoses
- Deep Vein Thrombosis (DVT): Although less common in the foot, DVT can cause pain and swelling in the leg, which might be perceived as radiating to the toes, especially if the clot is located in the lower extremities. It's crucial to rule out DVT due to its potential for severe complications like pulmonary embolism.
- Peripheral Artery Disease (PAD): This condition involves narrowing of the peripheral arteries, which can lead to pain in the legs or feet when walking (claudication) that improves with rest. While it typically affects the calf, severe cases can lead to pain in the toes.
Rare Diagnoses
- Erythromelalgia: A rare disorder characterized by burning pain, heat, and redness in the hands and feet, which can be exacerbated by heat, pressure, or prolonged standing. It's less likely but should be considered in the differential diagnosis due to its unique presentation.
- Complex Regional Pain Syndrome (CRPS): A chronic pain condition that most often affects one of the arms, legs, hands, or feet after an injury or trauma. It's characterized by intense burning or aching pain, along with other symptoms like swelling and changes in skin temperature and color. While rare, it's a diagnosis that should not be overlooked due to its significant impact on quality of life.