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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor
Category: Medical
Satisfied Customers: 31322
Experience:  MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
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I have pretty bad swelling, redness & pain in the 2nd toe on

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I have pretty bad swelling, redness & pain in the 2nd toe on my right foot, which started suddenly about 2-3 days ago. I am 63 yrs. old and have been recently diagnosed (6 mo's ago) with bone-on-bone osteoarthritis in that foot, and that pain had been going on for quite sometime before that. However, since that foot pain started, I had never before had anything like this swelling, redness & pain in any toe at all. I also have had Crohn's Disease since age 19, but that has been in remission for the most part for 25 years, even though when active it was so severe that I had many bowel resections, have had an ileostomy since age 27, and only have 6 ft. of small bowel left (since 1984) and only a few inches of colon. However, knowing my body as I do at this point, I don't feel this has anything to do with that. I suspect some kidney involvement, only because about 10 days or so ago, I had some pain (not severe, but definitely unusual for me) in the back above the waist on the left side one day & the right side the next, but then it went away. I have also been having some dizziness that is unusual for me, and what feels like heart palpitations maybe. I looked at info on gout last night online, but mostly couldn't identify with lifestyles, etc., that can lead to it. Never have I known to have high levels of uric acid. Blood work was done this past Jan. and uric acid was not elevated. Stress, however, has been huge lately, for a myriad of reasons. Any ideas? I have taken apple cider vinegar, total of maybe 3 tbs. since reading last night that it was helpful for gout, taken extra B-12, which is impossible for me to get any way but by injection or sublingual because of all the missing small intestine, as you know; I've been doing sublingual for several yrs., every day, and injections before that. B-12 was normal in Jan. I've never had gout symptoms before that I know of, but can't figure this toe thing out. If it is an infection, and the soaking for 1/2 hr. tonight in epson salts, along with the other things I've mentioned doing, does not make big difference by tomorrow, I suspect maybe I should go to Urgent Care, since my family practice gal is 2 hrs. each way from where I currently live, and I'm afraid that drive would be extremely uncomfortable under the circumstances. Thank you so much for any advice.
Submitted: 5 years ago.
Category: Medical
Expert:  Dr. Arun Phophalia replied 5 years ago.



As you have rightly suspected; this can be gout, despite that you never had an increased uric acid. The diagnostic test would be aspiration of the joint fluid as many times, attack of gouty arthritis can have normal serum uric acid. Your pain in the kidney area also can be due to uric acid crystals passing from the kidney causing pain. The other possibilites to consider would be;


1) Cellulitis of the toe; it is infection of the skin and subcutaneous tissue.

2) Crohn's related arthritis; joint pain is the most common extraintestinal manifestation of the Crohn's; despite it being in remission for last so many years. Please read about it;


I agree that going to urgent care is advisable for the x-ray and blood work.


Please feel free for your follow up questions.


I would be happy to assist you further, if you need any more information.


Dr. Arun

Customer: replied 5 years ago.

A couple questions, please. Because of all I read on different sites re gout last night,, the big toe was the only toe mentioned. So, it is possible that gout could be in the 2nd toe? Sounds like a dumb question, but don't know the answer for sure. Also, re uric acid crystals you mentioned, are you referring to kidney stones or something different? The pain I had for about 1 1/2 days was extremely minor compared to other pain I've had for Crohn's & other issues. I mention this because my best friend had kidney stones a few times and it was extremely painful, as I had already heard. Perhaps you're referring to a different condition. As far as the arthritis is concerned, I thought I was being so proactive having my family practice dr. check for the RA factor in blood work every year, going back 5-6 yrs, since my mother & all her siblings had it badly. Always negative. Then 2 yrs. ago was diagnosed with bone-on-bone osteoarthritis in my left shoulder, needing complete shoulder replacement, which I had done in Sept. 2009. Then finally having xrays on my right foot in Jan. and finding out about the severe osteoarthritis there! My dad had small issue in one knee with osteoarthritis is all, but obviously I took after him instead of my mom! But, since I've never had these symptoms before in any toe of the redness, swelling & pretty severe pain, I assumed that wasn't from the osteoarthritis. But can it be? I actually assumed it was from the osteoarthritis at first, but then decided to look up gout and got that info, a lot of which made sense, then concern about possibility of some kind of infection set into my head. Obviously that would not be good to let go, although I do not understand how I could have gotten this infection. Definitely no wound or anything like that. Also, I will look up Cellulitis to see if that makes sense to me for this.


I though perhaps another foot soak, next time with hydrogen peroxide, might make a difference, later this morning. It is so late now, I need to get to bed. If in the AM it does look better after the epson salts I used a few hrs. ago, and it looks even better & feels better after a hydrogen peroxide soak, do you feel perhaps it is safe enough to just play it by ear from there? I'd certainly rather not go to Urgent Care unless I have to, but I won't be silly about this either. I believe your answers to these questions will suffice, and I will go ahead & approve payment. Thank you very much.


Expert:  Dr. Arun Phophalia replied 5 years ago.



The big toe is the most commonly involved, but other toes may present with gout. Yes, I meant the kidney passing the uric acid crystals or small stones, which may be responsible for the pain. The pain of the kidney stones can be of varied intensity and is dependent on the size of the calculus and crystals and obstruction caused by them. So the pain can vary from, mild to moderate to severe in different individuals. The toe pain is not likely due to osteoarthritis, which does not cause swelling and redness and rarely have acute onset of pain and other symptoms and isolated toe involvement is very rare.


If your symptoms are better and hydrogen peroxide helps you further, you may wait and watch. If the symptoms are static or worsen; going to urgent care is warranted.


It is pleasure and privilege assisting you.


I hope this was helpful to you. If it was, please remember to ACCEPT the answer so I can get compensated for my work. If you have any more questions, please feel free to ask. I am truly privileged to help you, and I want to make sure that you are satisfied with the answer. Good luck!


Dr. Arun

Dr. Arun Phophalia and 3 other Medical Specialists are ready to help you
Customer: replied 5 years ago.
My apologies for taking so long here, but it was 5 am my time when I finished my last question to Dr. Arun and I had not been to bed yet. I'm a night owl, but that was getting pretty crazy even for me. It was already about 2:30 am my time last night when I discovered this site, but it seemed like a good thing to do, and was worth the $ to me. I very much appreciated that my questions were taken seriously and the answers seemed well thought through. I am happy with this process and thank Dr. Arun for his time and thoughtful answers.
Expert:  Dr. Arun Phophalia replied 5 years ago.

You are very welcome and thanks for your kind words.


Best regards,


Dr. Arun