Question
QUESTION: I have swelling and apparent inflamation on my second toe just below the nail and over the first joint.  It's raised and red, very sore whether with or without shoes. No pain emanating from the bottom of the foot. The toe is flexible without additional discomfort.

Please provide possibilities and suggestions.

Thank you.

Robert Kantor

ANSWER: Robert, with the information provided I can give you a list of about 100 differentials but I'll go with the most common:
- gout flare-up
- hammertoe with arthritic flare-up of the joint
- ingrown nail
- fracture

If you haven't injured the toe, then rule out a fracture.  If the nail is not painful, then it's not an ingrown nail.  If it is purely the joint that is bothering you, it could be a flare-up of arthritis from something like a hammertoe deformity or increased stressed to the joint from change in activity or shoes.  If you don't have a hammertoe, then I would consider gout.  It can occur in any joint in the foot; although the 2nd toe is not a common joint for a gout attack, I have seen it before.  I would try an anti-inflammatory such as ibuprofen or advil first.  You can try to offload that joint in shoes with a crest pad (sold in podiatry offices or online).  If that doesn't help, you should see a podiatrist to get an xray and further evaluation.  Hope this helps.  If there is any other information that you can give me for better differential diagnosis, please respond.

Sincerely,
Dr. Leslie Johnston, DPM

Tampa, FL
Advanced Podiatry

http://www.thetampapodiatrist.com
http://tampafootandanklepain.blogspot.com/
http://www.tampacryosurgery.com
http://katzpodiatristtampa.blogspot.com
http://twitter.com/TampaPodiatrist
http://www.notoenailfungus.com
http://www.vibranttampatoenails.com  
Advanced Podiatry Facebook Page


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

QUESTION: Thank you for your quick response.

There is no soreness in the nail. It is possible that I jammed the toe about a week ago. I have also been walking substantially more over the past three months as a result of adopting a dog.  I have also noticed a small red spot on the outside of the big toe on the other foot, but not sure it is related.

I saw photos of topis and there was some similarity I think. After further Internet research, I pressed against it and believe there is a lighter spot in the inflamation, which the research claimed could be crystals.

Not sure if this additional information helps.

Robert

Answer
I think the next step would be to have a uric acid test and see if you have hyperuricemia which causes gout attacks.  Your PCP or a podiatrist can order it for you.  If you've increased your activity level substantially since adopting your dog, it could also still be a painful, arthritic joint.  If the toe appears curled, it could be a painful hammertoe.

Sincerely,
Dr. Leslie Johnston, DPM

Tampa, FL
Advanced Podiatry

http://www.thetampapodiatrist.com
http://tampafootandanklepain.blogspot.com/
http://www.tampacryosurgery.com
http://katzpodiatristtampa.blogspot.com
http://twitter.com/TampaPodiatrist
http://www.notoenailfungus.com
http://www.vibranttampatoenails.com  
Advanced Podiatry Facebook Page