Differential Diagnosis for Intermittent Burning Pain in Big Toe

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 pain can be intermittent and burning, lasting from minutes to hours.

Other Likely Diagnoses

• Morton's Neuroma: A condition that affects the nerves between the toes, causing burning pain, numbness, or tingling, especially in the big toe. The pain can be intermittent and exacerbated by pressure or certain footwear.
• Ingrown Toenail: A common condition where the nail grows into the surrounding skin, causing pain, redness, and swelling. The pain can be burning and intermittent, especially if the ingrown toenail becomes infected.
• Peripheral Neuropathy: Damage to the peripheral nerves can cause burning pain, numbness, or tingling in the feet, including the big toe. The pain can be intermittent and may be related to various underlying conditions, such as diabetes.

Do Not Miss Diagnoses

• Deep Vein Thrombosis (DVT): Although less common, DVT can cause pain in the foot or toe, which may be intermittent and burning. It is crucial to consider DVT due to its potential for severe complications, such as pulmonary embolism.
• Osteomyelitis: A bone infection that can cause pain, redness, and swelling in the affected area, including the big toe. The pain can be intermittent and burning, and it is essential to diagnose and treat osteomyelitis promptly to prevent serious complications.
• Complex Regional Pain Syndrome (CRPS): A condition characterized by chronic pain, inflammation, and sensitivity in one limb, which can be triggered by an injury or trauma. The pain can be burning and intermittent, and CRPS should not be missed due to its potential for significant morbidity.

Rare Diagnoses

• Erythromelalgia: A rare disorder that causes burning pain, heat, and redness in the hands and feet, which can be intermittent. It is often associated with other conditions, such as myeloproliferative disorders.
• Fabry Disease: A genetic disorder that can cause burning pain in the hands and feet, among other symptoms. The pain can be intermittent and may be accompanied by other systemic symptoms.
• Sickle Cell Disease: A genetic disorder that can cause intermittent pain crises, including pain in the feet or toes, due to vaso-occlusive episodes.