What causes toe joint swelling?

From what I understand, your father has had toe joint pain for 3 months. There are quite a few questions I would like to further ask, to help come up with a possible diagnosis.

I assume there was no traumatic episode? and that the pain gradually developed over this time? Which toe is involved? is it the whole toe or one or more of the joints? Any associated foot or ankle pain as well? When does the pain happen? All the time? or with activity only? What kind of activities will cause the pain? Any pain at rest?

There are quite a few possibilities. Your father would need a thorough examination by an orthopedic surgeon, and the minimum radiological investigation would be an X-rays. X-rays are the most affordable modality of the radiological investigation, and the radiation is really not much. As we only do two standard views of the foot. We usually do both feet to compare, as there may be subtle differences that may be overlooked.

Toe joint pain can be caused by many problems, with the more common ones at this age group being arthritis, or sometimes even gout. If his pain is severe and affecting his lifestyle, he should really be encouraged to seek a professional opinion.

Management depends on what is the problem. Medication and sometimes physiotherapy/ podiatry would be the first line, and if the symptoms are not better, there may be a role for surgery. Nonetheless, a proper diagnosis should be made first.

Hope this helps

Dr Sean Ng

From the provided description, it sounds like gout, although there are of course other causes of toe joint swelling. This includes arthritis, infection, or an injury.

Here are some quick facts about gout:

• Gout is caused by uric acid crystals built up in the joints, and most commonly affects the big toe, causing swelling and pain
• A diet rich in alcohol and meat can increase the risks of gout
• Treatment involves medication to reduce pain and swelling, and to reduce the uric acid levels

The symptoms of gout tend to be progressive and will worsen over time if left untreated.

In Singapore, rheumatologists and GPs treat and manage gout cases regularly.

The best way to get your dad to seek help is probably to have a doctor he trusts (such as your family doctor) take time to explain more about the disease, and to reassure him about his concerns.

For example, the doctor can explain to your dad that gout is very common, and easily treatable. There are also minimal radiation risks from a foot X-Ray.

It's also helpful if you read more about the disease yourself, so that you can explain it to him, because he is likely to trust your advice.

Thanks for your question and I would certainly agree that

1. Gout is a reasonable possibility

2. An X-ray is a basic investigation and relatively low in cost

In the sports clinic, we have seen gout in a number of joints other than the toe, which is the typical text-book presentation. Usually, it affects a single joint and is hot, red and swollen. It responds well to medication and dietary changes.

As Dr Sean mentions, there can be other causes for the symptoms and certainly in older patients, OA cannot be ruled out. In some situations, we have helped patients with guided injections of the toe joint and sometimes have removed joint fluid for analysis in case of infection and other causes.

Your options are manifold and you can see an MSK/Sports Physician, a physiotherapist, a GP, a Rheumatologist or an Orthopaedic surgeon. All can assess you and direct you to further treatment. In your dad's case, starting with anti-inflammatories is not unreasonable, but then this is not a definitive solution.

I hope this helps.

BW

Dr Dinesh