Toe pain and swelling

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.


 * 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

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)