severe big toe pain

by mike
(houston, texas, USA)

ive never had any known injuries to my toe or foot but over time, and much more rapidly in recent days, the ball of my big toe has been causing me pain for no conceivable reason. ive always had crackly big toes and never thought anything of it but now the one of my right foot sometimes hurts to walk on. yesterday morning i woke up to some moderate pain and didnt think anything of it but today ive been woken up by severe pain at 6 am. it hurts even to try and move my big toe and walking on it is too painful. the pain in right in the first joint of my big toe and there is some moderate swelling.

RESPONSE

Hi Mike,

Since I have nothing else to go by other than your narrative, the first thing that comes to mind is a gout attack. I say this for the following reasons.

Typically, the big toe joint is the most common site for a gout attack. It is worth pointing out that it is not the only site, it can happen in other joints of the foot and to a lesser extent in the joints of the hand.

Secondly, the big toe joint will start to hurt with no history of trauma. Sound like you?

Lastly, the pain will usually begin in the early morning hours, again for no apparent reason. The reason this happens is because when you are sleeping and your legs are not in a dependent position, they actually cool down a bit simply because they are the furthest body part from the heart, so by the time the blood reaches your feet it is slightly cooler then the rest of the circulating blood.

This slight decrease in temperature is cool enough for the circulating uric acid to crystallize and get into the joint which then sets off an inflammatory reaction. This results in severe pain in the big toe joint along with swelling and redness.

The amount of pain that people experience with a gout attack can range from moderate pain to excruciating pain. It can be so painful, people cannot even put on a shoe or sock.

Typically, without treatment, the pain will last a few days and over this course of time, the pain will gradually become less and less severe, eventually reaching a point where there is virtually no pain. The only problem here is that it is impossible to predict when it will occur again. It could be months later or a short time later.

The only way to know if you actually are having a gout attack is to see a doctor. Most times the diagnosis is made simply by examination, as blood tests taken during the actual gout attack tend to be normal for uric acid, even though there are other indices that might be suggestive of gout.

Now, if it is not gout and again there is no history of trauma, the other thing I would consider would be an arthritic flare up in the joint. This would be an arthritic flare up probably from arthritic changes that the big toe joint has undergone.

I do not know how old you are or your overall medical condition, but lets say you are at least 40 years of age, there is a good possibility that the big toe joint has undergone some degree of arthritis and your every day activity might be enough to set off a flare up.

X-rays would be required to determine the condition of the joint to rule out an arthritic flare up as the source of pain.

Just for the sake of clarity, gout is considered an arthritic flare up, but what I am talking about in this instance is wear and tear on the joint which has caused it to become painful.

So the best advice I could give you would be to see a foot specialist in your area and let he or she determine what is going on with your foot.

Marc Mitnick DPM
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