Sharp severe pain in big toe when I point my foot down
I am 38 year old healthy, active female. About 3 weeks ago, I woke up, stretched and almost jumped out of my skin from pain...the top of my big toe down the entire side of my toe felt like someone had injected me with burning acid. Ever since, I cannot point my foot down such as when putting on pants or socks or point my toes without excruciating pain. It doesn't hurt to bend it, touch it, etc. I have no other pain anywhere in my foot and have no issues walking, wearing shoes, etc. It is limited only to the downward motion of my foot. I went to my orthopedist today and he was stumped...did xrays which showed some soft tissue swelling but no fractures and no pain in any other places. I was off the table with pain when he pointed my foot down. There was no injury, no change in activity, no new shoes, etc. He mentioned gout but doubted that was it (not exactly sure why). He ordered an MRI but I'm hoping that I can avoid that due to the costs. I also started on a prescription anti-inflammatory. I am desperate for a diagnosis!!
I too am stumped which is not a good way to start off this discussion. What we do know is that your pain only occurs when you perform a specific motion with your foot, which seems to be bending the
toe downwards. This tells me you are stretching something which then sets off the pain. If the pain is as excruciating as you state, then I would suspect it is a nerve that is being stretched and causing this much pain. The only other option would be a tendon being stretched, however, if the source was from a tendon I would think the tendon would continue to be sore even after it was "stretched" and would bother you to some extent even if you did not bend the foot and toe downward.
An MRI may or may not be of benefit, but before you do that you might want to consider a round of anti-inflammatory medication (which you are doing), but in addition I would have the toe immobilized in an effort to calm down whatever might be inflamed and causing the pain. If after a period of perhaps 3-4 weeks of this regimen, the pain is still present, then you might want to entertain an MRI.
As a side note, it does not sound like gout to me either. In gout, the big toe joint would be red and swollen, the toe would hurt regardless of what you were doing and of course in your case, it only happens when you move your foot and toe in a certain position. Secondly, gout is rare in women and tends to occur in post menopausal women when it does occur.
Marc Mitnick DPMDISCLAIMER