Differential Diagnosis for Intermittent Pain and Burning Sensation at Lateral Distal Nail of Great Toe

• Single Most Likely Diagnosis
  • Ingrown toenail: This condition is characterized by the nail growing into the surrounding skin, causing pain, redness, and swelling. The location at the lateral distal nail of the great toe is a common site for ingrown toenails due to pressure from poorly fitting shoes or improper nail trimming.
• Other Likely Diagnoses
  • Onychomycosis (fungal infection of the nail): Fungal infections can cause pain, discoloration, and brittleness of the nail, and may lead to a burning sensation.
  • Paronychia (infection of the skin around the nail): This condition can cause pain, redness, and swelling around the nail, often due to bacterial infection.
  • Morton's neuroma: Although more commonly associated with the third and fourth toes, a neuroma (benign growth) on the nerve between the toes can cause burning pain, especially if it affects the nerve supplying the great toe.
• Do Not Miss Diagnoses
  • Osteomyelitis (bone infection): While less common, an infection of the bone in the toe can cause severe pain and may present with similar symptoms. It's crucial to consider this diagnosis, especially if there's a history of trauma or signs of systemic infection.
  • Diabetic neuropathy: Individuals with diabetes may experience burning sensations in their toes due to nerve damage. This condition requires prompt management to prevent further complications.
  • Gout: Although gout typically affects the base of the big toe, it can occasionally cause pain and burning sensations in other parts of the toe, including the area around the nail.
• Rare Diagnoses
  • Erythromelalgia: A rare disorder characterized by burning pain, heat, and redness in the hands and feet. It could potentially cause symptoms in the toes.
  • Complex regional pain syndrome (CRPS): A condition characterized by intense burning or aching pain in the hands or feet after an injury or trauma. It's rare but could be considered if other diagnoses are ruled out and the pain is severe and persistent.