How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask T Khan Your Own Question

T Khan
T Khan, Doctor
Category: Medical
Satisfied Customers: 1097
Experience:  UW Med School/UCLA Training/USC Faculty. Full Spectrum Family Medicine - Adult, Peds, OB/GYN
33362630
Type Your Medical Question Here...
T Khan is online now
A new question is answered every 9 seconds

What can cause stabbing pain in the big toe?

Resolved Question:

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.

Submitted: 4 years ago.
Category: Medical
Expert:  T Khan replied 4 years ago.

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?

Customer: replied 4 years ago.

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.

Expert:  T Khan replied 4 years ago.

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:

- colchicine

- naproxen or indomethacin

- Vitamin C 8 grams daily for 3 days

- Rest

- Ice

- Elevation

 

- Chronic preventative management:

- vitamin C 1500 mg daily

- allopurinol

- Diet

 

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:

http://en.wikipedia.org/wiki/Gout

 

 

Hope this helps and good luck to you!

Customer: replied 4 years ago.
The pain is not in the joint. It is stabbing pain in the very tip of my great toe. It is a very different pain than my osteoarthritis.
Expert:  T Khan replied 4 years ago.

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?

T Khan, Doctor
Category: Medical
Satisfied Customers: 1097
Experience: UW Med School/UCLA Training/USC Faculty. Full Spectrum Family Medicine - Adult, Peds, OB/GYN
T Khan and 9 other Medical Specialists are ready to help you

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me. Susan O. USA
< Last | Next >
  • I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me. Susan O. USA
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
 
 
 

Meet The Experts:

 
 
 
  • Dr. Thomas, MD

    Board Certified Physician

    Satisfied Customers:

    46349
    Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
< Last | Next >
  • http://ww2.justanswer.com/uploads/DR/DrThomasMd/2012-7-25_134438_Imagess1.64x64.jpg Dr. Thomas, MD's Avatar

    Dr. Thomas, MD

    Board Certified Physician

    Satisfied Customers:

    46349
    Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
  • http://ww2.justanswer.com/uploads/MY/mysticdoc/2012-6-8_15615_mysticdoc3.64x64.jpg Dr. D.J.'s Avatar

    Dr. D.J.

    Board Certified Physician

    Satisfied Customers:

    14679
    MD
  • http://ww2.justanswer.com/uploads/agketch/2008-7-14_184046_drketchresized.jpg Dr. Ketch's Avatar

    Dr. Ketch

    Board Certified Physician

    Satisfied Customers:

    76
    Medical Degree, Former Assistant Professor at School of Medicine at Yale University
  • http://ww2.justanswer.com/uploads/FA/FamilyPhysician/2013-8-31_191624_JA550x500Photo.64x64.jpg Family Physician's Avatar

    Family Physician

    Doctor

    Satisfied Customers:

    2562
    Emergency Medicine and Family Practice for over 26 years
  • http://ww2.justanswer.com/uploads/DR/drappapo/2013-8-16_22576_drdavid.64x64.jpg Dr. David's Avatar

    Dr. David

    Board Certified Physician

    Satisfied Customers:

    224
    Treat children/young adults, former chief resident, multiple publications
  • http://ww2.justanswer.com/uploads/DrDLove/2009-08-12_141522_DrDLove.jpg Dr. D. Love's Avatar

    Dr. D. Love

    Doctor

    Satisfied Customers:

    11961
    Family Physician for 10 years; Hospital Medical Director for 10 years.
  • http://ww2.justanswer.com/uploads/CO/commissure/2011-4-15_192514_REISD20080926JR1090.64x64.jpg Dr. David's Avatar

    Dr. David

    Board Certified Physician

    Satisfied Customers:

    10667
    Experienced Physician trained in New York City. I'm ready to help.
 
 
 

Related Medical Questions

Chat Now With A Doctor
T Khan
T Khan
Doctor
1097 Satisfied Customers
UW Med School/UCLA Training/USC Faculty. Full Spectrum Family Medicine - Adult, Peds, OB/GYN