second toe swelling, gout?

its beeen 1 month now, i have consistantly worsening pain and swelling on top of and under the 2nd toe. All the other toes are fine and it hurts the minute i use the foot. At night i sleep fine but the second i put my foot on the ground it hurts. It is so ultra sensitive to touch on top, even to wear a sock, touch the fine hairs on the skin or take a shower. Throughout the day as i walk, it hurts more, and swells on top and on the ball underneath. The toe itself swells where the toe meets the foot. The toe isn't swollen, only where it joins the rest of the foot. i had it checked and the doctor told me i have a gout. and ask me to change my diet and hopefully it gets better. theres no change and im getting worried.

RESPONSE

Hi,

As I was reading through your narrative I was initially thinking gout as well. Gout may occur in any joint in the foot or ankle and if not properly treated, it can linger for a period of time. I wish I knew your sex and age as this is generally a male problem and usually only occurs in women who are post-menopausal.
However, the problem I have with gout as the diagnosis is the fact that in most gout attacks, the affected joint will hurt regardless of whether or not the patient is walking. Since the gout crystals irritate the joint, the joint will swell, become red and hot and will be consistently painful.
In your case it sounds like it does not bother too much until you attempt to walk, where it then becomes very painful. So although gout is a possibility, it certainly does not sound like a classic example.
Most cases of gout are self limiting, meaning that given a week or toe, the symptoms subside and once again this is not your case. Having said that I should note that I have seen cases where undiagnosed gout may continue beyond a week or two.
In any event I think it would be in your best interest to get an accurate diagnosis. In most initial gout attacks the blood uric acid level is actually normal so in initial attacks that type of test is a waste of time. You have had the problem for a while now, so at the very least I think you should have a blood test.
Additionally, you have to rule out of potential sources of this pain.
An arthritic flare up of the joint is another possibility. (again, I wish I knew your age and some other things about you). If this condition is actually an arthritic flare up, it would tend to hurt you when you walk and not so much when at rest.
Other conditions that could be causing your problem are some of the collagen diseases one of which is rheumatoid arthritis, as an example.
So in closing, although you may be having a gout attack and if you are, your doctor should have given you medication and not just told you to change your diet (although that is also necessary). You also need a work up to rule out some of the other possibilities I have mentioned.

Marc Mitnick DPM
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