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Tuesday, October 18, 2011

Swollen Big Toe: Email Advice

This is a comment I received on the below blog post yesterday. I need to emphasize that my comments are no substitute for someone who can feel the toe, see the toe, and order appropriate tests. I have to only talk in generalizations.


Hi. MY NAME IS NIGEL, I'M 49 YEARS OLD AND I PRESENT VERY SIMILAR SYMPTOMS TO ROBERT. INFLAMED RED TOE, SWELLING AND REDNESS OF THE ENTIRE, AND RESTRICTED TO THE TOE.

http://www.drblakeshealingsole.com/2011/03/swollen-big-toe-gout-or-infection.html


 MY TOENAIL ISN'T SORE EITHER, YET I DON'T SUFFER EXTREME DISCOMFORT WITH ANY OTHER KIND OF SHOE ON.
Dr Blake's comment: With a toe like this is either infection or gout. The redness is the most important sign of infection or gout. Other causes of swelling like arthritis, tendonitis, ganglion cysts, etc do not have the redness associated.


 I FIRST ENCOUNTERED IT ABOUT 2 MONTHS AGO, IT LASTS FOR ABOUT 3 TO 4 DAYS THEN IS GONE. WHAT I HAVE NOTICED IS THAT AFTER WEARING A SPECIFIC PAIR OF TACKIES,THE PROBLEM RAISES IT'S HEAD.
Dr Blake's comment: Gout can give you these transient symptoms that come and go. Infections normally just get worse and worse until the right treatment is started. The tackies (please see the great Wikipedia definition) must put very unique pressure/stress on the big toe that irritates it enough to set off the gouty inflammatory reaction which is lying in wait for something stimulus to irritate the soft tissue. It could be actual pressure (like tightness) or how it makes the toe work.
http://en.wikipedia.org/wiki/Tackies

 AFTER A FEW DAYS OF WEARING NORMAL SHOES AND SLIPPERS AT NIGHT, THE PROBLEM DISAPPEARS. I'VE TAKEN VOLTAREN TABLETS AND THIS APPEARS TO HELP. COULD THIS BE GOUT?
Dr Blake's comment: I would love to see what those Tackies do (but you may not be in San Francisco ??South Africa??) Definitely if the tackies irritate it only now, later there may be other triggers. So definitely get your Uric Acid Levels tested for Gout. Have xrays taken to rule out other causes of bone/joint inflammation. You may need a arthritis doctor to order a series of arthritis lab tests.
http://www.drblakeshealingsole.com/2010/09/gout-treat-symptoms-immediately.html


 I'VE RECENTLY UNDERGONE A CONCURRENT HEALTH ASSESSMENT WHERE BLOOD SAMPLES WERE TAKEN. WOULD THESE TESTS REVEAL ABNORMAL LEVELS OF URIC ACID IN THE BLOOD? OR SHOULD I ASK FOR SPECIFIC BLOOD TESTS?
Dr Blake's comment: The recent blood tests may have uric acid. See the blog post above for more info on that. If you are in the high normal range for uric acid, you probably have this syndrome I am discussing. If you are in the middle normal range, other causes of inflammation must be evaluated. Common lab tests are CRP (c reactive protein, HLA-B27, Rheumatoid Factor, sed rate, CBC with differential, etc). You really want a smart person ordering, since if you find a problem, you need advice on what to do with that information.

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.