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Sporadic pain at base of second toe

by Linda
(Belmont, CA, USA)

I am a 47-year-old woman. I do not wear high heals because I have a history of intermittent back pain. I wear prescription orthotics and usually wear very comfortable good shoes that give my toes plenty of wiggle room.

A few years ago, totally out of the blue, the second toe on my left foot began hurting. I remember feeling tremendous pain in my sleep one night, and upon waking found that my toe was killing me -- as if someone had hammered on it overnight!

I went to my podiatrist. She took an x-ray but found nothing wrong. We thought perhaps I had Raynaud's syndrome, because a few days previous to the pain my toes had been very cold and had turned blue. (I had been outside in sandals at night and it was colder than I'd expected -- my feet had been freezing cold). I went to a specialist who ruled out Raynaud's. She said that the pain would have happened immediately after my toes turning blue...not several days later.

The pain disappeared in about a week and didn't come back until about a year later. At that time, I thought perhaps those particular pair of sandals (which have a 1 1/2 inch heel -- and which I was wearing the night my toes turned blue) were causing the problem. Perhaps they were putting too much pressure on that area of my foot. So I decided not to wear the sandals anymore. I went back to my podiatrist, and this time she said perhaps I have a nerouma.

My foot was fine for over a year, and then again it appeared out of the blue. But this time I was not wearing any sandals or "bad" shoes. I was wearing good shoes I'd been wearing for months, with my RX orthotic! Upon closer manual investigation and palpitation of my toe, I realized that the toe itself wasn't hurting -- it was the area directly beneath the second toe (where the toe "attaches" to the ball of the foot). When I press in on that area, it is painful.

Lately the pain keeps coming and going, but for no discernable reason. Last night I felt it building up as I slept, and when I awoke sure enough it was so painful I had to limp. I've taken strong RX NSAID anti-inflammatories today but they didn't seem to touch the pain.

In your opinion, what is going on with my toe/foot? Is it Morton's Neruoma, Capsulitis, or something entirely different like a pinched nerve somewhere else? My second toe IS longer than my great toe, but not by much...certainly not as much as photos I've seen of other people's toes with Morton's.

Visually the toe appears totally normal, not swollen or bruised or anything. I don't have any abnormalities on my feet such as bunions or hammertoes or anything like that. My toe nails have always been rather brittle, but I doubt that has anything to do with this, either.

I would greatly appreciate your opinion. Thank you!

Hi Linda,
Initially, upon reading your story my first thought was a gout attack, but you are kind of young for that (as a female), and upon finishing your story it sounds like you may have capsulitis.
Here is why I like gout:
1. Occurs for no apparent reason
2. many times will occur at night
3. pain will be excruciating; may not respond to medication.
4. pain will be present for a period of time and then disappear

Here is why I like capsulitis:
1. usually will be the result of wearing a certain shoe or performing a certain activity; remove either contributing factor and the pain should subside.
2. the area you "pointed" to is exactly where capsulitis occurs.

So...based on your story I am getting mixed signals. So what can you do? You might ask your doctor to rule out gout. One way would be to take colchicine the next time you have an attack; it is specific for gout, if it helps then you had a gout attack, if no help, then no gout.
Does your prescription orthotics have a metatarsal pad built into it and is it thick enough? If you are having capsulitis then the metatarsal pad should be very beneficial.
Unfortunately because I do not have the luxury of examining you, that is the best I can do based on your description of the problem.
Good luck.
Marc Mitnick DPM

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Sep 29, 2011
THIS Story could have been MINE!
by: Cheryl

Linda, thanks for sharing your story. Your case seems almost identical to mine, except that my 2nd toe is shorter than my big toe. I've been searching the internet for symptoms just like mine, with no luck until now... Like yours, my pain was out of the blue, in only the last joint of my 2nd toe. I'd been at work for a couple of hours, sat in a 2-hour meeting... when I got up to leave, OUCH! I limped the whole way back to my desk, and every step was excruciating. My symptoms had my podiatrist waffling too, between gout and capsulitis. The toe itself didn't hurt when manipulated. But when the doctor pressed the area on the bottom of my foot, just at the base of the toe - ZING!! OWWWEEeeee!! The pain evolved into a throbbing, radiating pain that came and went during the day, and woke me up at night. My toes swelled a little, and were hot. I'm still awaiting the results of my Uric Acid test, but in the mean time, the doctor put me in an AirCast boot (to take the pressure off the ball of my foot) and put on Naproxen. The Naproxen reduced the worst of the pain (but not much); the 5th day after onset was the first I saw a noticeable reduction in pain. Day 7 - didn't take the Naproxen, and I'm in sandals, and have only a little discomfort in my toe. WHAT A RELIEF.

May 11, 2008
Thank you!
by: Linda

Thank you for taking the time to get back to me!

It has been several days since I posted my question to you and the pain in my toe is slowly going away.

I did some research about gout and I doubt that gout is my problem, although I will be sure to mention it to my doctor. I had a full exam a few months ago and I know that all my "levels" of things were OK at that time. I'm not overweight and I don't have any od the lifestyle or dietary problems associated with gout, or a family history of the disease. It's possible that this is capsilitus. What is quite odd is the way the pain seems to come about at night while I'm sleeping -- which is how gout is described. I will be sure to talk to my podiatrist about it.

I was against getting a cortisone shot in my foot but now I'm a little more open to the idea. An I'll also explore re-doing my orthotics. However, I think that part of the problem may be some of the shoes I wear in the summer that do not include my orthotics. THAT is a problem!

Even though there is a strong possibility that you are not having a gout attack, please be aware that most times uric acid levels are normal during a gout attack so it can be misleading. That is why I suggested taking Colchicine next time you have an attack. It is specific for gout, so if it made the pain go away, you would know its gout; if no relief from Colchicine then you could be reasonably sure it was not gout.
I do not know where you are in your journey through life but gout is generally limited to post menopausal women, so that would be a consideration as well.
Good luck.
Marc Mitnick DPM

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