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I have stabbing pain at the end of my right big toe. The pain feels like an ice pick being pushed into the tip. It has happened 3 times in last two 2 weeks, and has woke me up once, and twice while sitting. Also, have pulsing vibration on side of left foot and 3rd-5th toes. Vibration is mild, approx 1/2 as fast as heart beat, only noticeable when seated.
Welcome to JA - sorry you are going through this.Do you have any medical problems or take any medications? Other symptoms? Is it swollen or red?
No edema or erythema. Histroy includes: mild scoliosis, mild osteoarthritis, Gerd & IBS controlled by diet & Prilosec, possible lactose intolerance, depression controlled by Prozac, osteoarthritis controlled by Ca+D and Fosamax. I am an RN. Exercise regularly walking & weight machines, height 5'5'', weight 140. Frequent neck pain: use heat, Tylenol, occasionally Skelaxin, nonsmoker, glass wine 2-3 times weekly.
Great - thanks for that info.
As a RN, I'm sure you know that all small joint arthritis has to be ruled out for auto-immune arthritis. Thus, before anything else, you need an ANA/ESR/CRP to rule out this.
Next, there aren't many other causes of small joint arthritis.
1) osteoarthritis --> not likely given the time frame
2) osteomyelitis --> not likely if you have no signs of infxn
3) Gout --> possible. You should get a blood uric acid level and joint tap.
4) Pseudogout --> Very possible given the situation above and a joint tap is the best way to know this.
Treatment of gout is multifold: 1) what a doctor can do for a patient and 2) what a patient can do for themselves.
1) What a doctor can do for a patient
- Acute flare:
- naproxen or indomethacin
- Vitamin C 8 grams daily for 3 days
- Chronic preventative management:
- vitamin C 1500 mg daily
2) What a patient can do for themselves:
Forbidden Very high purine content. Herring, herring roe, meat extracts, mussels, Sardines, yeast (brewer's and baker's). Alcohol : Alcohol contains no purine but interferes with uric acid excretion.Liver
Avoid High purine content - not more than one item once a week. Anchovies, bacon, chicken soup, Beef, mutton leg, mutton chop, pheasant, salmon, sausage, trout, turkey, veal, venison, lobster, crab.
Moderation Moderate purine content-not more than one item 4 times a week. Asparagus, bass, bouillon, brains, cauliflower, chicken, duck, halibut, ham, kidney beans, lentils, Lima beans, liverwurst, mushrooms, oysters, peas, plaice, pork, rabbit, roe, shad, spinach, tongue, tripe, tuna, wholegrain cereals and bread.
Acceptable Low or no purine content - as often as desired. Beverages -tea, coffee, cocoa, chocolate Carbonated soft drinks Fruit juices Sugar, sweets Vegetables : (except those under BE CAREFUL) Vegetables and cream soups (no meat stock) Butter, fats of all kinds (in moderation) Bread (except wholegrain) Cereals (except wholegrain) Cheese : all kinds (in moderation) Eggs Fruit Milk - buttermilk, condensed, malted Nuts - all kinds, peanut butter
Drink plenty of water (2-3 litres per day) to help flush uric acid through the kidneys. Please note - if you have cardiac or kidney disease, your doctor may actually require fluid restriction - and you should consult him regarding fluid intake allowance. Keep dietary fat to a minimum.
Be careful not to damage the joint.
Take your prescribed medication regularly.
Read here for Gout information:
Hope this helps and good luck to you!
I see - that makes a neruopathy more concerning or a problem with the nail bed.
You will need the nail examined of course but the other thing you may want to consider is a platelet/coags/and workup for vascular disease to make sure this isn't from micro vascular disease.
Otherwise, you may want to consider a trial of lyrica or neurontin. Does this help?