Question
QUESTION: Hi! Early this morning, I was woke up with an intense, throbbing pain in the tip of my big toe on my right foot. The throbbing was so intense and painful that I was full-body sweating, and could barely walk because the pressure of standing. The pain/throbbing was localized to a half-inch area that wrapped around the tip of my toe to the outer left edge. So it wasn't near the nail, and it wasn't at all near the joint. (Note: I抳e had many infected hangnails before when I was a dancer, so I definitely know the difference, though this pain did feel similar卪ultiplied by 100). The toe/area was not swollen, wasn抰 red or inflamed, no burning sensations, had no puncture wounds/cuts/breaks/bites. It was, however, warm to the touch and painful to touch. I hadn抰 hurt my toe or banged it or done anything prior. This was completely out of the blue and irregular. I took three ibuprofen and waited. After two hours, the throbbing finally stopped, and I drifted back to sleep. It抯 been 6 hours since this incident, and though the throbbing hasn抰 come back, the area still has some residual pain and soreness, probably a 4/10 on the pain scale, and it抯 kind of uncomfortable to walk on or wear shoes with. I抳e been incredibly worried since, because this incident made no sense to me. My best friend has gout and said that what I described is nothing like gout梟ot that he抯 a doctor, of course梥o I have no idea what it could be! I would love any of your thoughts, even though I know an examination is the best course of treatment. Thanks!

ANSWER: Hi, Barbara,

So sorry to hear that you've been experiencing such intense, unexplainable pain!  If I were you, I would definitely see a podiatrist as soon as possible.  Gout was one of the first things that came to mind when I began reading your message.  It may not follow all the "classic" signs, but waking up with excruciating pain that is warm and tender to the touch is one of the hallmarks of gout.  I also considered an ingrown nail, an insect bite (maybe near the edge of the nail), or perhaps an injury in your sleep.  Could something have happened without you realizing or remembering it in the morning?  Also, try to think of anything unusual that might have happened a day or a few days before.  Change in shoes?  Sudden increase in activities?  An injury during the day or some time before bed?  I admit, it is a bit mysterious.  And without being able to see your toe or get x-rays, it's hard for me to come up with the right diagnosis.  Hopefully you can see someone soon so they can do a thorough examination and help you figure out what's going on.

I hope this helps at least a little.  May you heal quickly and feel better soon!

Wishing you health, happiness, and peace,
Dr. Bodart


---------- FOLLOW-UP ----------

QUESTION: Oh, no! Gout sounds so scary! I forgot to note that I'm a 23-year-old female who is also very health-conscious (i.e. vegan--though I eat fish--and fitness buff). On the plus side (maybe), my toe barely hurts anymore (so about 15 hours post-incidence), and the only thing out of the ordinary is it is that the area is slightly warm to the touch, still. I hate medical anomalies! It's pretty much been the story of my life with health issues...

I have an appointment with a podiatrist for Friday, though I'm a little hesitant to go, mainly because my post-college insurance make things like x-rays and gout tests and blood draws totally unaffordable.

Sorry for the additional information--I'm sure you must get tired of people trying to get more and more information from you. It's just incredibly comforting and helpful having a physician give you an articulate and quick response. I sincerely appreciate it, and thank you again!

Answer
Hi, Barbara,

No need to apologize!  That's what forums like this are all about.  Maybe the podiatrist will know exactly what's going on without having to do too many extra tests.  X-rays are pretty standard, though, and it's definitely something I would order, after hearing your description.

I wouldn't worry too much about the possibility of gout.  As I suggested, it's one of many potential diagnoses and might not be what you have (or had).  The good news is that although the condition is quite painful, gout is relatively easy to treat, and the body responds very quickly to the treatment and feels as good as new, often within a day or two of treatment.

Best of luck to you, and let me know if there's anything else I can help you with.

Wishing you health, happiness, and peace,
Dr. Bodart