Toe pain and swelling
| Toe pain and swelling |
Template:Search infobox Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Causes can be as simple as trauma or infection. They can also be rheumatoid arthritis, endocarditis or athlerosclerotic vascular disease. The most common cause/complaint is Gout.
Gout can be so excruciating at times that even the weight of a bed sheet is unbearable.
Differential Diagnosis
In alphabetical order. [1] [2]
- Cholesterol emboli
- Infective endocarditis
- Ingrown toenail
- Pseudogout
- Seronegative spondyloarthropathy
- Septic arthritis
- Trauma
Laboratory Findings
- CBC
- Electrolytes
- BUN / creatinine
- Calcium
- Magnesium
- Phosphorus
- ESR
- [[Blood cultures]
- Lyme titers
- Iron (psudogout)
- Synovial fluid analysis
Imaging Findings
- Radiographs
- Fractures
- Osteomyelitis signs
- Psoriatic arthritis
Other Diagnostic Studies
- Synovial fluid analysis
- Look for an infection, crystals, inflammation
- Gram stain, polarized light microscopy
- Cell counts should result in a WBC count less than 50,000/ml if inflamed
- Cell counts should result in a WBC count greater than 50,000/ml in infectious arthritis
Treatment
Acute Pharmacotherapies
Gout
- NSAID's
- Colchicine
Chronic Pharmacotherapies
Gout
- Urate lowering agents
- Colchicine
Ingrown toenails
- Warm soaks
- Toe nail removal
Pseudogout
- NSAIDs
- Corticosteroids
- Colchicine
Reiter's Syndrome
- Prednisone
- Local steroid injection
- Sulfasalazine
- Methotrexate
- Indomethacin
Septic arthritis
- Ceftriaxone -> gram negative infections
- Cefazolin -> gram positive (add gentamicin for psudomonal infections)