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Painful Big Toe

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  #1  
Old 9th November 2009, 02:03 PM
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Default Painful Big Toe

Hello;

I woke up with pain in left foot big toe joint. I was thinking that it may be gout but it doesn't have the associated burning pain sensation or redness. The pain is more centralized in the second joint rather than the ball joint of the big toe. It hurts to walk and aches when I sit for a long period of time. I can bend the big toe down (flex the joint down), but not up (limited range of motion, stiff). If i put pressure on the second joint of the big toe it feel like the tendons are inflamed (the tendons feel stringy and stiff). There is no pain in the tendons in the middle of the foot, in the other toes, ankle (or any other joints), or in the Achilles tendon (heel pain).

I have recently started jumping rope again for exercise after a year of inactivity and I think I may have injured the toe somehow - though I have been careful in not overdoing it (60 second x 5 jumping intervals). I have not jumped rope in 2 days.

What precipitated all this was the toe felt stiff this morning in bed, and when I was flexing it up and down - I felt a sudden pain and that is when the general uncomfortableness started. Since then the pain is worse either when I walk or sit for a long period of time - if I flex the toe down the pain subsides somewhat. The toe joint is a little swollen I think, but mainly stiff and aching.

It seems to me like tendonitis, I have had problems in the past few years with a my Achilles tendon in the same foot and with the plantar facillis - which I have attributed to repetitive stress injuries (I am a male, 39, and due to inactivity about 30lbs overweight). I stopped jumping rope for a year to give the Achilles a chance to heal without re injuring it.

Now I am thinking it might be gout from what I have read online, even though the symptoms don't match. Currently I am just applying heat to the area which seems to be working (less stiff). My plan was to give it two days with rest, heat and Tylenol - then see if it would get better. But if this is gout maybe I should see a doctor and get a blood test if this is an attack.
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  #2  
Old 9th November 2009, 04:31 PM
FootDoc FootDoc is offline
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Default Re: Painful Big Toe

DISCLAIMER:
THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS-ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
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I can only offer my impressions based on what you have reported, and as such this does not constitute anything approaching a diagnosis. But based on the fact that your pain may be associated with your jumping rope, during which you would have probably would have tended to bounce up and down on a perhaps hyper-dorsiflexed interphalangeal joint of the the great toe, it is entirely possible that you sustained a stress injury to its plantar capsule. Such, when it occurs at the metatarso-phalangeal joint of the great toe is generically termed "turf toe," but owing to the natural limitation of dorsiflexion of the interphalangeal joint, it is probably less severe. Acute gout is almost always accompanied by heat and redness, and when it occurs in the great toe, generally affects the metatarso-phalangeal joint rather than just the interphalangeal joint. There COULD be a tendonitis associated with it, but that is probably less likely than a capsular sprain. It should be examined for a definitive diagnosis, but more likely than not, unless a fracture has occurred, the treatment will probalby be rest and some sort of physical therapy. But be sure to see a podiatrist for a definitive opinion rather than making assumptions.
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Last edited by FootDoc; 9th November 2009 at 04:35 PM.
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  #3  
Old 10th November 2009, 03:27 AM
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Default Re: Painful Big Toe

Thank you for your reply.

I think you are correct that it is some kind of sprain. I had a rest for a few hours and there was almost no pain when I woke up. However when I started walking around again the pain started up again. The bottom of the ball of my toe feels a little swollen, but the pain feels more like it is in the tendons. After the rest I could flex the toe up a little, but then it stiffened up again, so I can't flex it up but I can curl it down. If I press down on the effected areas I can feel pain where the joints move/tendons connect (metatarso-phalangeal joint and interphalangeal joint). At rest or walking the pain seems to be centralized in the bottom of the metatarso-phalangeal joint and the bottom of the interphalangeal joint in the tendon/muscle connectors (they feel stringy/enflamed). If I physically manipulate the toe up the pain is more centralized in the interphalangeal joint. The reason I suspected gout is that it feels like there is a swollen area on the bottom of the metatarso-phalangeal joint, it sort of feels like a fluid sack but it might just be enflamed. It only feels painful if I manipulate the joint or walk on it, it will throb if I walk for a while and rest - but then it will subside and there is no pain.

It is a little frustrating I seem to keep re-injuring my left foot. I had heel and mid foot (plantar facillis) tendon pain when I was jumping rope more aggressively (pain in the morning that would dissipate in an hour after I got up, but it was chronic - more than a month), so I dialed back the jumping rope considerably until the chronic pain subsided. Then in that same time frame, I strained my Achilles (year and a half ago) after hiking (which I attributed to weakened muscles from the chronic tendon pain). After taking 6 weeks off and switching to swimming I aggravated it again and took another six weeks off. Since then I have been avoiding putting to much stress on it to the point where I stopped doing any cardio or strength training that would stress the Achilles (every time I would over stress the Achilles I would get a severe calf muscle cramp and ankle pain, and would hobble around for a couple of weeks avoiding putting any pressure on the back of my heel). I have only had two episodes where I have had extreme Achilles pain (shot gun going off in your ankle/calf). But I have had many episodes where I bang my heel the wrong way and I get a painful heel/stiff ankle for a few days which I generally address with RICE, heat, rest and Tylenol.

I can understand picking up a sprain due to going from a period of inactivity to exercising again - but I was really careful in not pushing it too hard as I started up again. The only thing I can think of is that I bought new runners and maybe they impacted the situation, causing a sprain.

Assuming this is a minor sprain and it goes away completely in a few days - how long would you generally wait until exercising again, a week or two? My general methodology with these injuries has been to do a very light workout and wait two days to see if there is any pain. However with these tendon related injuries I don't want to aggravate it and re-injure.

I am also thinking of getting one of those therapeutic socks with the elastic attachment from the toe to the lower leg they recommend for Achilles injuries so that the foot remains in a 90 degree position and the calf muscles/tendon doesn't contract at night when you sleep.

On the upside I am hopeful that it isn't gout - I will take a painful sprain over the possibility of gout any day of the week...god I hate getting old...

;-)
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Old 10th November 2009, 06:35 AM
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Default Re: Painful Big Toe

Quote:
Originally Posted by Unregistered View Post
Assuming this is a minor sprain and it goes away completely in a few days - how long would you generally wait until exercising again, a week or two?
DISCLAIMER:
THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS- ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
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That wouldn't sound unreasonable, but there is no hard and fast rule in such a matter. Be gentle when you return to activity and see how it goes.
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